Provider Demographics
NPI:1821578337
Name:REYES, MARICAR
Entity Type:Individual
Prefix:
First Name:MARICAR
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MOUNTAINSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKHOLM
Mailing Address - State:NJ
Mailing Address - Zip Code:07460-1904
Mailing Address - Country:US
Mailing Address - Phone:551-221-5931
Mailing Address - Fax:
Practice Address - Street 1:230 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4020
Practice Address - Country:US
Practice Address - Phone:845-363-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY749427163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health