MEDICARE: MS. CYNTHIA A REA RN, C, BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	26NO11081600	NJ

General Provider Information

NPI Number	:	1366581803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA A REA RN, C, BA

Provider Business Mailing Address
First Line	:	14 WESTERN AVE
Second Line	:
City	:	BUTLER
State	:	NJ
Zip	:	07405-1622
Country	:	US
Telephone Number	:	973-838-0322
Fax Number	:	973-492-1930

Provider Business Practice Location Address
First Line	:	2201 BERGENLINE AVE
Second Line	:	2ND FLOOR
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3582
Country	:	US
Telephone Number	:	201-558-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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