Individual
DR. MICHAEL RIESA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2301 S BROAD ST RM 112, PHILADELPHIA, PA 19148-3542
(215) 510-2176
Mailing address
151 FRIES MILL RD STE 301, TURNERSVILLE, NJ 08012-2016
(565) 134-1248
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
25MB09676000
NJ
282N00000X
General Acute Care Hospital
Primary
OS020721
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0467618
—
NJ
Enumeration date
06/20/2012
Last updated
10/20/2020
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