Provider Demographics
NPI:1780602177
Name:REYES, JONATHAN VILLAROMAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:VILLAROMAN
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LINCOLN HWY STE 500
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3961
Mailing Address - Country:US
Mailing Address - Phone:732-516-9868
Mailing Address - Fax:
Practice Address - Street 1:2 LINCOLN HWY STE 500
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3961
Practice Address - Country:US
Practice Address - Phone:732-516-9868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07160300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02300567Medicaid
H49664Medicare UPIN
NY02300567Medicaid