Healthcare Provider Details

I. General information

NPI: 1609268580
Provider Name (Legal Business Name): BRIDGEWAY REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 BLOOMFIELD AVE SUITE 201, 2ND FLOOR
BLOOMFIELD NJ
07003-3307
US

IV. Provider business mailing address

615 N BROAD ST
ELIZABETH NJ
07208-3409
US

V. Phone/Fax

Practice location:
  • Phone: 908-355-7886
  • Fax: 908-355-6668
Mailing address:
  • Phone: 908-355-7886
  • Fax: 908-355-6668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number204010248
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. ROSITA JIMENEZ-HAIRSTON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 908-355-7886