Healthcare Provider Details

I. General information

NPI: 1578010393
Provider Name (Legal Business Name): PAOLA NATALI REYNOSO- MANOOK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAOLA NATALI REYNOSO

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 VALLEY RD # 148
MONTCLAIR NJ
07042-2709
US

IV. Provider business mailing address

55 BROAD ST 21ST FLOOR
NEW YORK NY
10004-2501
US

V. Phone/Fax

Practice location:
  • Phone: 973-559-4600
  • Fax: 855-998-4358
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: