Healthcare Provider Details

I. General information

NPI: 1578721999
Provider Name (Legal Business Name): JACQUELINE REYES APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 10/28/2026
Certification Date: 10/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 FOREST AVE
PARAMUS NJ
07652
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD BLDG 2
RED BANK NJ
07701-5688
US

V. Phone/Fax

Practice location:
  • Phone: 201-267-0902
  • Fax:
Mailing address:
  • Phone: 862-244-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ00314100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: