Healthcare Provider Details

I. General information

NPI: 1881667277
Provider Name (Legal Business Name): BEACHWOOD LOW BACK REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date: 04/14/2009
Reactivation Date: 04/16/2009

III. Provider practice location address

137 ATLANTIC CITY BLVD SUITE 2
BEACHWOOD NJ
08722-2935
US

IV. Provider business mailing address

137 ATLANTIC CITY BLVD SUITE 2
BEACHWOOD NJ
08722-2935
US

V. Phone/Fax

Practice location:
  • Phone: 732-244-8666
  • Fax: 732-244-0450
Mailing address:
  • Phone: 732-244-8666
  • Fax: 732-244-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA03808800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00497000
License Number StateNJ

VIII. Authorized Official

Name: DR. STEVEN J POLLACK
Title or Position: DIRECTOR
Credential: DC
Phone: 732-244-8666