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General NPI Number Information
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NPI Number | 1841488541
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Entity Type | Organization
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Legal Business Name | TENNEY MOUNTAIN INTERNAL MEDICINE
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 251 MAYHEW TPKE
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City | PLYMOUTH
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State | NH
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Zip | 03264-3026
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Country | US
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Telephone | 603-536-6355
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Fax | 603-536-6356
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Provider Business Mailing Address
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Address Line | 251 MAYHEW TPKE
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City | PLYMOUTH
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State | NH
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Zip | 03264-3026
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Country | US
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Telephone | 603-536-6355
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Fax | 603-536-6356
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFERY REISERT
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Credential | DO
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Telephone | 603-536-6355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9969
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License Number State | NH
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