Provider Demographics
NPI:1053366948
Name:MICHELLE REISNER, M.D., L.L.C.
Entity type:Organization
Organization Name:MICHELLE REISNER, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:R
Authorized Official - Last Name:REISNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-332-3354
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-0729
Mailing Address - Country:US
Mailing Address - Phone:201-332-3354
Mailing Address - Fax:201-536-9047
Practice Address - Street 1:196 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1804
Practice Address - Country:US
Practice Address - Phone:201-332-3354
Practice Address - Fax:201-536-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010050929NJ01OtherANTHEM
NJ2032576001OtherAMERIHEALTH
NJ1075405OtherHORIZON NJ HEALTH
NJ1640475OtherAETNA TRADITIONAL PLANS
NJ3914500Medicaid
NJHUL000097-07OtherAMERICHOICE
NJ1022776OtherHORIZON NJ HEALTH
NJ391536OtherCIGNA
NJ45671OtherAETNA HMO
NJ23072OtherAMERIGROUP
NJ264AH2OtherWELLCHOICE
NJ15262OtherPPONEXT
NJ264AH1OtherWELLCHOICE
NJ380001858OtherRAILROAD MEDICARE
NJ809742OtherUNITED HEALTHCARE
NJHP231OtherOXFORD
NJHUL000097-08OtherAMERICHOICE
NJHP231OtherOXFORD