Provider Demographics
NPI:1508297441
Name:REYNA, JENNIFER (MSED BIL CERTIFIED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REYNA
Suffix:
Gender:F
Credentials:MSED BIL CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 E 163RD ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-4290
Mailing Address - Country:US
Mailing Address - Phone:347-602-1200
Mailing Address - Fax:
Practice Address - Street 1:2541 BOUNDBROOK BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-8648
Practice Address - Country:US
Practice Address - Phone:347-602-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
174H00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator