1992836431 NPI number — JERSEY REHAB PA

Table of content: (NPI 1992836431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992836431 NPI number — JERSEY REHAB PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERSEY REHAB PA
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:
WESTCHESTER REHABILITATION
Provider Other Organization Name Type Code:
5
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:
1992836431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
234 MOUNT PROSPECT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07104-2006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-482-1614
Provider Business Mailing Address Fax Number:
973-485-6126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 NEWARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07109-4143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-844-9220
Provider Business Practice Location Address Fax Number:
973-844-9221
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GANGEMI
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
973-482-1614

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  25MA05600600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: 25MA06101800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: 25MA06101800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081S0010X , with the licence number: 25MA05600600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1184656373 . This is a "DR MARINI NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1962433524 . This is a "DR GANGEMI NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0037435 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7198302 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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