Individual
DR. EDGARDO V. REYNOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
308 WILLOW AVE, RADIOLOGY DEPARTMENT, HOBOKEN, NJ 07030-3808
(201) 418-1820
(201) 418-1822
Mailing address
10335 N PORT WASHINGTON RD, SUITE 250, MEQUON, WI 53092-5763
(262) 240-9870
(262) 240-9869
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA02746300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00498577
—
NY
05
—
0576603
—
NJ
Enumeration date
06/19/2006
Last updated
10/31/2007
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