Healthcare Provider Details

I. General information

NPI: 1053821405
Provider Name (Legal Business Name): REYNALDO LUIS PELLA NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 ESSEX ST
HACKENSACK NJ
07601-1215
US

IV. Provider business mailing address

493 ESSEX ST
HACKENSACK NJ
07601-1215
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-9244
  • Fax: 201-996-9243
Mailing address:
  • Phone: 201-996-9244
  • Fax: 201-996-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00768600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: