Healthcare Provider Details

I. General information

NPI: 1326529942
Provider Name (Legal Business Name): MOSHE REICH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 BETHEL CHURCH RD
JACKSON NJ
08527-1712
US

IV. Provider business mailing address

874 BETHEL CHURCH RD
JACKSON NJ
08527-1712
US

V. Phone/Fax

Practice location:
  • Phone: 347-424-5927
  • Fax:
Mailing address:
  • Phone: 347-424-5927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR16062300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number656811
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343600
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: