Provider Demographics
NPI:1023093721
Name:RIEBER, JONATHAN MAX (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MAX
Last Name:RIEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEADOW ROAD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:718-412-3445
Mailing Address - Fax:212-567-8480
Practice Address - Street 1:5030 BROADWAY
Practice Address - Street 2:SUITE 707
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034
Practice Address - Country:US
Practice Address - Phone:718-412-3445
Practice Address - Fax:212-567-8480
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203024207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02250420Medicaid