Provider Demographics
NPI:1043240518
Name:REISS, ROBERT CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:REISS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TRIANGLE CENTER
Mailing Address - Street 2:SUITE 215
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598
Mailing Address - Country:US
Mailing Address - Phone:914-962-5413
Mailing Address - Fax:914-962-1186
Practice Address - Street 1:40 TRIANGLE CENTER
Practice Address - Street 2:SUITE 215
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598
Practice Address - Country:US
Practice Address - Phone:914-962-5413
Practice Address - Fax:914-962-1186
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX24342Medicare ID - Type Unspecified