Provider Demographics
NPI:1669631461
Name:REEIS-MARTIN, TALI (MD)
Entity type:Individual
Prefix:
First Name:TALI
Middle Name:
Last Name:REEIS-MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TALI
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:161 RIVERSIDE DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4176
Mailing Address - Country:US
Mailing Address - Phone:607-798-6700
Mailing Address - Fax:
Practice Address - Street 1:134 HOMER AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1206
Practice Address - Country:US
Practice Address - Phone:607-428-5074
Practice Address - Fax:607-758-8210
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03186629Medicaid