Individual provider Active NPI

Vanna A Reisman, CNM

  • Obstetrics & Gynecology Nurse Practitioner
  • East Syracuse, NY
National Provider Identifier
1801878640
Registry record updated Mar 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
F360502-1 Issued in NY
Practice address
824 Franklin Park Dr.
East Syracuse, NY 13057
Phone
(315) 432-1048
Fax
(315) 432-9219
NPI assigned
Nov 17, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X F0005381 NY
Obstetrics & Gynecology Nurse Practitioner 363LX0001X F360502-1 NY Primary

Addresses

Primary practice location

824 Franklin Park Dr.
East Syracuse, NY 13057

Mailing address

824 Franklin Park Dr.
East Syracuse, NY 13057
Phone (315) 432-1048

Other identifiers 1

IdentifierTypeStateIssuer
02185537MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
F0005381NYMDMidwife
F360502-1NYMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Antosh MD PC PastSince Mar 22, 2020 Accepting new patients
David M. Girardi, OD, LLC PastSince Mar 22, 2020 Accepting new patients
Cathy J. Berry, M.D., P.C. Obstetrics & Gynecology Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: vanna.reisman@howardmweinsteinmdpc.chartmakerdirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1801878640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 FRANKLIN PARK DR.",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "13057",
            "telephone_number": "315-432-1048",
            "fax_number": "315-432-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 FRANKLIN PARK DR.",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "13057",
            "telephone_number": "315-432-1048",
            "fax_number": "315-432-9219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REISMAN",
        "first_name": "VANNA",
        "middle_name": "A",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-17",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "NY",
            "license": "F0005381",
            "primary": false
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "NY",
            "license": "F360502-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02185537",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.