MEDICARE: MR. STUART H REICH PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	001965	NY
2	363A00000X	Physician Assistant	PA3075	FL
3	363AS0400X	Surgical Physician Assistant	001965	NY

General Provider Information

NPI Number	:	1235129669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STUART H REICH PA

Provider Business Mailing Address
First Line	:	115 FRANKLIN TPKE STE 238
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-1325
Country	:	US
Telephone Number	:	845-357-2548
Fax Number	:	888-972-3703

Provider Business Practice Location Address
First Line	:	115 FRANKLIN TPKE STE 238
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-1325
Country	:	US
Telephone Number	:	845-357-2548
Fax Number	:	845-261-0436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	11/28/2023

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