=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023461241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER N. REYES, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2016
-----------------------------------------------------
Last Update Date | 07/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 W 57TH ST SUITE 511-512
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-935-0719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 W 57TH ST SUITE 511-512
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-935-0719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JENNIFER N REYES
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 212-935-0719
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 055865
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------