1487749040 NPI number — DR. ARACELI O BORBON-REYES M.D.

Table of content: DR. ARACELI O BORBON-REYES M.D. (NPI 1487749040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487749040 NPI number — DR. ARACELI O BORBON-REYES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORBON-REYES
Provider First Name:
ARACELI
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487749040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 BRAEBURN PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-465-2584
Provider Business Mailing Address Fax Number:
973-465-2668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 JEFFERSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-465-2584
Provider Business Practice Location Address Fax Number:
973-465-2668
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZC0500X , with the licence number:  MA51169 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: MA51169 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5640202 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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