Healthcare Provider Details

I. General information

NPI: 1134024243
Provider Name (Legal Business Name): REYMOND JAMES BURGOS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 DEMOTT LN STE 203
SOMERSET NJ
08873-4875
US

IV. Provider business mailing address

26 THORNTON LN
PISCATAWAY NJ
08854-5044
US

V. Phone/Fax

Practice location:
  • Phone: 732-873-2777
  • Fax:
Mailing address:
  • Phone: 908-380-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00962000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: