Provider Demographics
NPI:1104903202
Name:REYES, PRUDENCIO CANTRE (MD)
Entity type:Individual
Prefix:DR
First Name:PRUDENCIO
Middle Name:CANTRE
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 BRAEBURN PL
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2383
Mailing Address - Country:US
Mailing Address - Phone:732-238-8093
Mailing Address - Fax:732-238-8093
Practice Address - Street 1:135 BLOOMFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5902
Practice Address - Country:US
Practice Address - Phone:973-743-3556
Practice Address - Fax:973-743-3895
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA 40990207PE0004X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery