Provider Demographics
NPI:1871518704
Name:BART, REYNA ECLIPSE (LPN)
Entity type:Individual
Prefix:MS
First Name:REYNA
Middle Name:ECLIPSE
Last Name:BART
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 YELLOWSTONE BLVD APT 7L
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3169
Mailing Address - Country:US
Mailing Address - Phone:917-703-9909
Mailing Address - Fax:
Practice Address - Street 1:7025 YELLOWSTONE BLVD APT 7L
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3169
Practice Address - Country:US
Practice Address - Phone:917-703-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260175-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse