Healthcare Provider Details

I. General information

NPI: 1588784425
Provider Name (Legal Business Name): REKA SOMODI MANFRE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 ROUTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

3400 SPRUCE ST 5 RHOADS
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4949
  • Fax: 732-776-4843
Mailing address:
  • Phone: 215-662-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00128200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: