Provider Demographics
NPI:1578010393
Name:REYNOSO- MANOOK, PAOLA NATALI (NP)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:NATALI
Last Name:REYNOSO- MANOOK
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:PAOLA
Other - Middle Name:NATALI
Other - Last Name:REYNOSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 BROAD ST
Mailing Address - Street 2:21ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28 VALLEY RD # 148
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2709
Practice Address - Country:US
Practice Address - Phone:973-559-4600
Practice Address - Fax:855-998-4358
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily