Provider Demographics
NPI:1811214943
Name:REYES, CECILIA V (APN)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:V
Last Name:REYES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 MEISEL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2315
Mailing Address - Country:US
Mailing Address - Phone:973-218-0846
Mailing Address - Fax:
Practice Address - Street 1:50 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2414
Practice Address - Country:US
Practice Address - Phone:973-808-5550
Practice Address - Fax:973-808-5999
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00279300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily