Provider Demographics
NPI:1346586039
Name:REYNOSO, JAY JOSEPH ABANDO
Entity Type:Individual
Prefix:MR
First Name:JAY JOSEPH
Middle Name:ABANDO
Last Name:REYNOSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E NAYLOR MILL RD
Mailing Address - Street 2:UNIT F
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2308
Mailing Address - Country:US
Mailing Address - Phone:757-710-2240
Mailing Address - Fax:
Practice Address - Street 1:300 MILL POND LN APT 115
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2113
Practice Address - Country:US
Practice Address - Phone:443-944-0037
Practice Address - Fax:443-210-2473
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009218225100000X
DEJ1-0002942225100000X
MD24491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist