Provider Demographics
NPI:1770230922
Name:PIERRE, REAGEN
Entity Type:Individual
Prefix:
First Name:REAGEN
Middle Name:
Last Name:PIERRE
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 1:81 NORTHFIELD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5343
Mailing Address - Country:US
Mailing Address - Phone:973-991-9829
Mailing Address - Fax:973-419-0414
Practice Address - Street 1:81 NORTHFIELD AVE STE 202
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5343
Practice Address - Country:US
Practice Address - Phone:973-991-9829
Practice Address - Fax:973-419-0414
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2300047341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance