Healthcare Provider Details

I. General information

NPI: 1821578337
Provider Name (Legal Business Name): MARICAR REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N MAIN ST
SPRING VALLEY NY
10977-4020
US

IV. Provider business mailing address

24 MOUNTAINSIDE AVE
STOCKHOLM NJ
07460-1904
US

V. Phone/Fax

Practice location:
  • Phone: 845-363-8140
  • Fax:
Mailing address:
  • Phone: 551-221-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number749427
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: