Provider Demographics
NPI:1932360781
Name:FRANK REDA MD PA
Entity Type:Organization
Organization Name:FRANK REDA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:REDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-240-2700
Mailing Address - Street 1:129 ROUTE 37 W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6435
Mailing Address - Country:US
Mailing Address - Phone:732-240-2700
Mailing Address - Fax:
Practice Address - Street 1:129 ROUTE 37 W
Practice Address - Street 2:SUITE 3
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6435
Practice Address - Country:US
Practice Address - Phone:732-240-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA067520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7649002Medicaid
126391Medicare PIN
NJG79031Medicare UPIN
NJ016580Medicare PIN