=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700694890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIAN REYES RAMOS FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2024
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 LACEY RD STE A
-----------------------------------------------------
City | WHITING
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08759-2985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-350-0404
-----------------------------------------------------
Fax | 732-350-2001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 65 LACEY RD STE A
-----------------------------------------------------
City | WHITING
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08759-2985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-350-0404
-----------------------------------------------------
Fax | 732-350-2001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ15216400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------