Provider Demographics
NPI:1154305621
Name:REISER, IRA W (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:W
Last Name:REISER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 BROOKDALE PLZ
Mailing Address - Street 2:ROOM 169CHC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-5615
Mailing Address - Fax:718-485-4064
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:ROOM 169CHC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5615
Practice Address - Fax:718-485-4064
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2013-10-11
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Provider Licenses
StateLicense IDTaxonomies
NY148732207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14-27202OtherUNITED HEALTHCARE
NY2348368OtherAETNA US HEALTHCARE-HMO
NY70D45OtherBLUECHOICE
NY0003314OtherGHI
NY051AG1OtherEMPIRE BC/BS
NY148732OtherHIP
NY148732-B41Other1199 NBF
NY3300266OtherGHI
NY70D451OtherMEDICARE PTAN
NY00947071Medicaid
NYKS446OtherOXFORD
NY9159486001OtherCIGNA - REGULAR
NY148732-A41Other1199 NBF
NY9159486003OtherCIGNA - SENIORS
NYP2085145OtherOXFORD
NY0582188OtherAETNA US HEALTHCARE
NY10855OtherELDERPLAN
NY5279175OtherAETNA US HEALTHCARE-PPO
NYBKX076001OtherAMERICHOICE