Provider Demographics
NPI:1376638833
Name:REYES, REINA DUREMDES (MD)
Entity Type:Individual
Prefix:DR
First Name:REINA
Middle Name:DUREMDES
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 GROPP AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-2048
Mailing Address - Country:US
Mailing Address - Phone:609-581-1830
Mailing Address - Fax:609-581-1830
Practice Address - Street 1:1230 WHITEHORSE-MERCERVILLE RD.
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:609-581-1700
Practice Address - Fax:609-581-9957
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA075934208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH22000Medicare UPIN