Provider Demographics
NPI:1063513018
Name:REISS, WESLEY BETH (DO)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:BETH
Last Name:REISS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3046
Mailing Address - Country:US
Mailing Address - Phone:631-425-6180
Mailing Address - Fax:516-797-7370
Practice Address - Street 1:14 W NECK RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2619
Practice Address - Country:US
Practice Address - Phone:631-425-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159835204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0727234OtherAETNA
NY0082445OtherGHI
NYP951291OtherOXFORD
NY266380883OtherCIGNA
NY49430OtherVYTRA
NYNYM159835OtherCARE MANAGEMENT GROUP NY
NYN11973OtherHEALTHNET
NYD91820Medicare UPIN
NY0727234OtherAETNA