Provider Demographics
NPI:1528441623
Name:REINOSO, KAROLINE ANDREA (PA-C)
Entity type:Individual
Prefix:
First Name:KAROLINE
Middle Name:ANDREA
Last Name:REINOSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAROLINE
Other - Middle Name:ANDREA
Other - Last Name:ESCOBEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 ROUTE 66 FL 3
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2645
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:
Practice Address - Street 1:516 LAWRIE ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3046
Practice Address - Country:US
Practice Address - Phone:732-549-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
NJ25MP00467900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant