Provider Demographics
NPI:1396812954
Name:REYES, JOSE FRANCO DOCTOR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE FRANCO
Middle Name:DOCTOR
Last Name:REYES
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 1:104 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1039
Mailing Address - Country:US
Mailing Address - Phone:856-885-4529
Mailing Address - Fax:856-885-6258
Practice Address - Street 1:104 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1039
Practice Address - Country:US
Practice Address - Phone:856-885-4529
Practice Address - Fax:856-885-6258
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA720542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ054996C2BOtherMEDICARE BILLING NO.
NJG80831Medicare UPIN