=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114077302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEWART ROY REITER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 07/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 BEACHWOOD IBC PA 35 BEECHWOOD ROAD STE A B
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-598-2400
-----------------------------------------------------
Fax | 908-598-2408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 BEECHWOOD RD STE 3AB
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901-4604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-598-2400
-----------------------------------------------------
Fax | 908-598-2408
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 54974
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------