MEDICARE: DR. RAPHAEL REISS M.D.

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	207V00000X	Obstetrics & Gynecology Physician	133426	NY

General Provider Information

NPI Number	:	1558333013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAPHAEL REISS M.D.

Provider Business Mailing Address
First Line	:	6905 YELLOWSTONE BLVD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3753
Country	:	US
Telephone Number	:	718-544-8400
Fax Number	:	718-263-5401

Provider Business Practice Location Address
First Line	:	6905 YELLOWSTONE BLVD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3753
Country	:	US
Telephone Number	:	718-544-8400
Fax Number	:	718-263-5401

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/18/2022

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