Provider Demographics
NPI:1972169597
Name:REYA, NAFISA (MD)
Entity Type:Individual
Prefix:
First Name:NAFISA
Middle Name:
Last Name:REYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BUCHANAN AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-3855
Mailing Address - Country:US
Mailing Address - Phone:609-442-1605
Mailing Address - Fax:
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:484-862-3159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHS000009L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice