Provider Demographics
NPI:1164316345
Name:REISER, DANIEL JOHN (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:REISER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:65 1/2 MAIN ST APT A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1449
Mailing Address - Country:US
Mailing Address - Phone:516-662-5688
Mailing Address - Fax:
Practice Address - Street 1:105 MARYS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5829
Practice Address - Country:US
Practice Address - Phone:845-338-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical