Healthcare Provider Details

I. General information

NPI: 1457044687
Provider Name (Legal Business Name): SHOSHANA LEAH REINHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 PALISADE AVE
TEANECK NJ
07666-3144
US

IV. Provider business mailing address

3 UNIVERSITY PLZ STE 205
HACKENSACK NJ
07601-6208
US

V. Phone/Fax

Practice location:
  • Phone: 201-353-9000
  • Fax: 201-530-0003
Mailing address:
  • Phone: 201-833-3599
  • Fax: 201-227-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01012000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: