Provider Demographics
NPI:1194109975
Name:REBUSTES, JOSE BULLECER III (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:BULLECER
Last Name:REBUSTES
Suffix:III
Gender:
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 TALMADGE RD UNIT 1337
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2860
Mailing Address - Country:US
Mailing Address - Phone:862-235-4767
Mailing Address - Fax:
Practice Address - Street 1:590 N 7TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-4553
Practice Address - Country:US
Practice Address - Phone:973-596-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-12
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15308100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health