Provider Demographics
NPI:1336182716
Name:REDA, FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:REDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ROUTE 37 W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6435
Mailing Address - Country:US
Mailing Address - Phone:732-240-2700
Mailing Address - Fax:732-240-1304
Practice Address - Street 1:129 ROUTE 37 W
Practice Address - Street 2:SUITE 3
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6435
Practice Address - Country:US
Practice Address - Phone:732-240-2700
Practice Address - Fax:732-240-1304
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA067520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7649002Medicaid
NJ7649002Medicaid
G79031Medicare UPIN