1225048697 NPI number — CHRISTOPHER KIM REHAB.,INC.

Table of content: (NPI 1225048697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225048697 NPI number — CHRISTOPHER KIM REHAB.,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER KIM REHAB.,INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1225048697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 REVERE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08820-1907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-669-0077
Provider Business Mailing Address Fax Number:
732-669-0076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 PROGRESS ST # 36
Provider Second Line Business Practice Location Address:
SUITE A 7
Provider Business Practice Location Address City Name:
EDISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08820-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-669-0077
Provider Business Practice Location Address Fax Number:
732-669-0076
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
732-669-0077

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  25MA07159600 , 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: 8968209 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com