Provider Demographics
NPI:1073959904
Name:REYNOSO, JOSEPHINE (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OCEANA DR E
Mailing Address - Street 2:APARTMENT 1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6691
Mailing Address - Country:US
Mailing Address - Phone:917-325-4010
Mailing Address - Fax:
Practice Address - Street 1:125 OCEANA DR E
Practice Address - Street 2:APARTMENT 1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6691
Practice Address - Country:US
Practice Address - Phone:917-325-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-19
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant