Doctor Name: | DR. CHRISTOPHER JACOB REISS |
NPI Number: | 1023183654 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 007640-1 |
Business Practice Address: | 1311 Virginia St Far Rockaway, NY - 116914630 |
Business Phone Number: | 7322248212 |
Business Fax Number: | 7322247675 |
Mailing Address: | Po Box 8399, RED BANK |
State: | NJ |
Postal Code: | 077018399 |
Phone Number: | 7322248212 |
Fax Number: | 7322247675 |
NPI Enumeration Date: | 11/21/2006 |
NPI Last Update Date: | 04/23/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 007640-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |