1467697086 NPI number — INTEGRITY REHABILITATION AMBULATORY THERAPY AND WELLNESS SERVICES LLC

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 1467697086 NPI number — INTEGRITY REHABILITATION AMBULATORY THERAPY AND WELLNESS SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRITY REHABILITATION AMBULATORY THERAPY AND WELLNESS SERVICES LLC
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:
1467697086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 IRIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08234-6105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-442-1212
Provider Business Mailing Address Fax Number:
609-645-3439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 TILTON RD
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
NORTHFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08225-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-241-6339
Provider Business Practice Location Address Fax Number:
609-241-6348
Provider Enumeration Date:
12/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTOPHER
Authorized Official First Name:
RUDOLPH
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-442-1212

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA00810700 , 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)





Copyright © 2007-2024 www.npivalidator.com