INNOVATIVE PRACTICE FORM

Name: Jeffrey Reser

Address: 12261226 Atlantic Ave., Atlantic City, NJ 08401

Phone #: 609-348-3113

FAX #: 609-344-6374

Briefly describe innovation

Rx compounding, troches, gels, suppositories (special rectal rockets)

Method of Reimbursement

Payor(s): cash only--fee-for-service