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General NPI Number Information
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NPI Number | 1932462397
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Entity Type | Individual
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Provider Name | MICHAEL RIESA D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 2301 S BROAD ST RM 112
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City | PHILADELPHIA
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State | PA
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Zip | 19148-3542
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Country | US
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Telephone | 215-510-2176
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Fax |
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Provider Business Mailing Address
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Address Line | 151 FRIES MILL RD STE 301
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-2016
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Country | US
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Telephone | 565-134-1248
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 25MB09676000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | OS020721
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License Number State | PA
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