1104203330 NPI number — KATRIEL REHAB INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104203330 NPI number — KATRIEL REHAB INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATRIEL 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:
1104203330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1374 WHITEHORSE HAMILTON SQUARE RD
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08690-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-609-7155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1374 WHITEHORSE HAMILTON SQUARE RD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08690-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-609-7155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GOTTUMUKKALA
Authorized Official First Name:
PRATHIBHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
732-609-7155

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  40QA01534600 , 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: 1124385901 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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