Provider Demographics
NPI:1821200403
Name:REEVES, DONALD RAYMOND JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RAYMOND
Last Name:REEVES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 RAYMOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANG
Mailing Address - State:NJ
Mailing Address - Zip Code:07079
Mailing Address - Country:US
Mailing Address - Phone:973-378-9599
Mailing Address - Fax:973-378-9599
Practice Address - Street 1:112 RAYMOND AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH ORANG
Practice Address - State:NJ
Practice Address - Zip Code:07079
Practice Address - Country:US
Practice Address - Phone:973-378-9599
Practice Address - Fax:973-378-9599
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA066410002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8136904Medicaid
NJ8136904Medicaid
G17450Medicare UPIN