Provider Demographics
NPI:1336596402
Name:PERL, REINA (BC-PNP, IBCLC, RN)
Entity Type:Individual
Prefix:MRS
First Name:REINA
Middle Name:
Last Name:PERL
Suffix:
Gender:F
Credentials:BC-PNP, IBCLC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 COLUMBUS AVE
Mailing Address - Street 2:APT 4H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1400
Mailing Address - Country:US
Mailing Address - Phone:908-208-7386
Mailing Address - Fax:
Practice Address - Street 1:600 COLUMBUS AVE
Practice Address - Street 2:APT 4H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1400
Practice Address - Country:US
Practice Address - Phone:908-208-7386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY42014163WL0100X
NY382673363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics