MEDICARE: MARTIN BERNARD REISS DO

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	2084P0800X	Psychiatry Physician	1273	AZ
2	2084P0800X	Psychiatry Physician	894700	NY

General Provider Information

NPI Number	:	1427052869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN BERNARD REISS DO

Provider Business Mailing Address
First Line	:	5110 N 40TH ST
Second Line	:	STE 104
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2143
Country	:	US
Telephone Number	:	602-955-8055
Fax Number	:	602-955-6865

Provider Business Practice Location Address
First Line	:	5110 N 40TH ST
Second Line	:	STE 104
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2143
Country	:	US
Telephone Number	:	602-955-8055
Fax Number	:	602-955-6865

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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Directions to “ MARTIN BERNARD REISS DO” Practice Location

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