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Individual

JUAN L. RIESTRA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
70 PARK ST, MONTCLAIR, NJ 07042-5907
(973) 655-9300
(973) 439-5780
Mailing address
1 RUBINO RD, WEST CALDWELL, NJ 07006-8033
(973) 985-1698
(973) 439-5780

Taxonomy

Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
25MA05785800
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7886802
NJ
Enumeration date
04/19/2006
Last updated
08/30/2010
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