Provider Demographics
NPI:1306959762
Name:REYNOLDS, JANET DREW (APNC)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:DREW
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:APNC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:401 HAMBURG TURNPIKE
Mailing Address - Street 2:STE 303
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-790-9222
Mailing Address - Fax:973-790-0671
Practice Address - Street 1:401 HAMBURG TURNPIKE
Practice Address - Street 2:STE 303
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-790-9222
Practice Address - Fax:973-790-0671
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26N005349500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0027146Medicaid
NJ0027146Medicaid
S42429Medicare UPIN