Individual
JOHN MICHAEL REISER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
40 BIRDSONG PKWY, ORCHARD PARK, NY 14127-3068
(716) 574-2672
Mailing address
40 BIRDSONG PKWY, ORCHARD PARK, NY 14127-3068
(716) 574-2672
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
193975
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025112506
UNIVERA
—
01
—
000525977008
BLUE SHIELD OF WESTERN NY
—
05
—
02060997
—
NY
01
—
208616656
FIDELIS
—
01
—
5611064
INDEPENDENT HEALTH
—
01
—
CR1939750B
WORKERS COMPENSATION
NY
01
—
P00259090
RAILROAD MEDICARE
NY
01
—
P00422403
RAILROAD MEDICARE
—
Enumeration date
07/28/2005
Last updated
07/24/2012
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