Provider Demographics
NPI:1134170491
Name:REYES, LESLIE CHARI
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:CHARI
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 1:59 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1403
Mailing Address - Country:US
Mailing Address - Phone:973-948-8899
Mailing Address - Fax:
Practice Address - Street 1:45 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2323
Practice Address - Country:US
Practice Address - Phone:973-931-1717
Practice Address - Fax:973-582-9289
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00391900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist