Healthcare Provider Details

I. General information

NPI: 1154121499
Provider Name (Legal Business Name): JORDY RUANE REYES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ARCTIC PKWY
EWING NJ
08638-3040
US

IV. Provider business mailing address

PO BOX 7053
EWING NJ
08628-0053
US

V. Phone/Fax

Practice location:
  • Phone: 609-888-4844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number26NR18721300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: