Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | MA 40990 | NJ |
N | 208200000X | Surgeon | MA 40990 | NJ |
N | 208600000X | Surgeon | MA 40990 | NJ |
NPI | 1104903202 |
---|---|
Provider Name | Dr. Prudencio Cantre Reyes |
First Address | East Brunswick, NJ 08816-2383 |
Second Address | Bloomfield, NJ 07003-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |