Healthcare Provider Details

I. General information

NPI: 1376757351
Provider Name (Legal Business Name): PROSPECT REHABILATATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 BROAD ST
BLOOMFIELD NJ
07003-3000
US

IV. Provider business mailing address

324 W CLINTON AVE
BERGENFIELD NJ
07621-1903
US

V. Phone/Fax

Practice location:
  • Phone: 973-893-9300
  • Fax: 973-893-0073
Mailing address:
  • Phone: 201-522-5588
  • Fax: 201-384-3380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. JOSEPH V THOMAS
Title or Position: PRESIDENT
Credential:
Phone: 201-522-5588