Healthcare Provider Details

I. General information

NPI: 1487629598
Provider Name (Legal Business Name): CHRISTINE M REYNOLDS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WASHINGTON ST
NEWARK NJ
07102-3026
US

IV. Provider business mailing address

259 W CHRYSTAL ST
RANDOLPH NJ
07869-1423
US

V. Phone/Fax

Practice location:
  • Phone: 973-622-3900
  • Fax: 973-622-1698
Mailing address:
  • Phone: 973-361-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number26NN03938200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: