Provider Demographics
NPI:1790285567
Name:JOSEPH, RENY RACHEL (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:RENY
Middle Name:RACHEL
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:RENY
Other - Middle Name:
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:714 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:SECACUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094
Mailing Address - Country:US
Mailing Address - Phone:201-865-2050
Mailing Address - Fax:201-865-0015
Practice Address - Street 1:714 10TH STREET
Practice Address - Street 2:
Practice Address - City:SECACUS
Practice Address - State:NJ
Practice Address - Zip Code:07094
Practice Address - Country:US
Practice Address - Phone:201-865-2050
Practice Address - Fax:201-865-0015
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00798100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily