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General NPI Number Information
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NPI Number | 1962925495
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Entity Type | Organization
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Legal Business Name | JANA DOSZTAN-REISS, INC.
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 4800 BEAR RD
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City | LIVERPOOL
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State | NY
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Zip | 13088-4604
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Country | US
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Telephone | 315-457-9946
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 152
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City | SKANEATELES
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State | NY
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Zip | 13152-0152
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Country | US
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Telephone | 315-391-6645
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Fax | 866-581-2235
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | PAUL MOGREN
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Credential |
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Telephone | 315-391-6645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F302363-1
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License Number State | NY
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