Provider Demographics
NPI:1346822186
Name:JEAN, REYNALD (NURSE)
Entity Type:Individual
Prefix:MR
First Name:REYNALD
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 TUSCAN RD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3028
Mailing Address - Country:US
Mailing Address - Phone:908-937-5759
Mailing Address - Fax:
Practice Address - Street 1:225 TUSCAN RD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3028
Practice Address - Country:US
Practice Address - Phone:908-937-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450365135OtherPRIVATE