1861903940 NPI number — ROZMAN MEDICAL REHABILITATION INC

Table of content: (NPI 1861903940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861903940 NPI number — ROZMAN MEDICAL REHABILITATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROZMAN MEDICAL REHABILITATION 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:
1861903940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 WYCOFF WAY W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-5649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CENTER PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TINTON FALLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-9744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-505-4554
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ROZMAN
Authorized Official First Name:
ANATOLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
815-505-4554

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  25MA10203800 , 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: 25MA10203800 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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