Provider Demographics
NPI:1326529942
Name:REICH, MOSHE (FNP)
Entity Type:Individual
Prefix:
First Name:MOSHE
Middle Name:
Last Name:REICH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1712
Mailing Address - Country:US
Mailing Address - Phone:347-424-5927
Mailing Address - Fax:
Practice Address - Street 1:874 BETHEL CHURCH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1712
Practice Address - Country:US
Practice Address - Phone:347-424-5927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16062300163W00000X
NY656811163WE0003X
NY343600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency