Individual
DR. JACOB M REIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1714 ROUTE 9 STE A, HALFMOON, NY 12065-3111
(518) 900-1115
Mailing address
1714 ROUTE 9 STE A, HALFMOON, NY 12065-3111
(518) 900-1115
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
201064
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000401055002
BSNENY
NY
05
—
01744843
—
NY
01
—
070315000059
FIDELIS
NY
01
—
08953
MVP
NY
01
—
10021142
CDPHP
NY
01
—
200150
SENIOR WHOLE HEALTH
NY
01
—
3686D1
EMPIRE BC
NY
01
—
52560
GHI/HMO
NY
01
—
5634708
AETNA
NY
Enumeration date
09/29/2006
Last updated
02/17/2023
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