Provider Demographics
NPI:1134170673
Name:REYES, NANCY (APN-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1018
Mailing Address - Country:US
Mailing Address - Phone:973-586-2941
Mailing Address - Fax:201-536-9047
Practice Address - Street 1:196 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1804
Practice Address - Country:US
Practice Address - Phone:201-536-9000
Practice Address - Fax:201-536-9047
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00063300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
081559Medicare ID - Type Unspecified
Q20643Medicare UPIN