Healthcare Provider Details

I. General information

NPI: 1306139316
Provider Name (Legal Business Name): HASBROUCK HEIGHTS REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 ROUTE 46 SUITE G5
CLIFTON NJ
07013-2451
US

IV. Provider business mailing address

1037 ROUTE 46 SUITE G5
CLIFTON NJ
07013-2451
US

V. Phone/Fax

Practice location:
  • Phone: 973-928-5360
  • Fax: 973-928-5358
Mailing address:
  • Phone: 973-928-5360
  • Fax: 973-928-5358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JITENDER PRASAD
Title or Position: PRESIDENT
Credential: MD
Phone: 973-928-5360