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General NPI Number Information
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NPI Number | 1942858527
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Entity Type | Individual
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Provider Name | MS. YVETTE ALTAGRACIA REYNOSO
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Gender | Female
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 655 WESTFIELD AVE
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City | ELIZABETH
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State | NJ
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Zip | 07208-1398
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Country | US
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Telephone | 908-352-8375
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Fax | 908-352-8858
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Provider Business Mailing Address
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Address Line | 37 COOLIDGE PL
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City | HACKENSACK
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State | NJ
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Zip | 07601-1307
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Country | US
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Telephone | 201-245-8171
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 221487364
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License Number State | NJ
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