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General NPI Number Information
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NPI Number | 1497393094
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Entity Type | Individual
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Provider Name | CORINNE LEIGH RIESER PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 301 ROUTE 73 NORTH
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City | WEST BERLIN
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State | NJ
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Zip | 08091
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Country | US
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Telephone | 844-542-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 3 KATHRYN CT
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City | MARLTON
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State | NJ
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Zip | 08053-2347
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Country | US
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Telephone | 856-495-6770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00554300
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License Number State | NJ
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