Provider Demographics
NPI:1023155504
Name:REISBERG, BARRY (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:REISBERG
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 1:20 WATERSIDE PLAZA
Mailing Address - Street 2:SUITE # 7K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2619
Mailing Address - Country:US
Mailing Address - Phone:212-889-7579
Mailing Address - Fax:212-263-6991
Practice Address - Street 1:20 WATERSIDE PLAZA
Practice Address - Street 2:SUITE # 7K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2619
Practice Address - Country:US
Practice Address - Phone:212-889-7579
Practice Address - Fax:212-263-6991
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD 1170712084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB13616Medicare UPIN