Provider Demographics
NPI:1548331929
Name:DELOS REYES, JENNIFER I (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:I
Last Name:DELOS REYES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WESTSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2836
Mailing Address - Country:US
Mailing Address - Phone:718-409-8964
Mailing Address - Fax:718-792-2048
Practice Address - Street 1:MMG - BRONX EAST
Practice Address - Street 2:2300 WESTCHESTER AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:718-409-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist