Healthcare Provider Details

I. General information

NPI: 1295882041
Provider Name (Legal Business Name): COMPLETE PHYSICAL REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NEWARK AVE STE 212
ELIZABETH NJ
07208-3560
US

IV. Provider business mailing address

701 NEWARK AVE STE 212
ELIZABETH NJ
07208-3560
US

V. Phone/Fax

Practice location:
  • Phone: 908-527-6001
  • Fax: 908-527-6634
Mailing address:
  • Phone: 908-527-6001
  • Fax: 908-527-6634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00071700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. JAMES PUMARADA
Title or Position: PRESIDENT
Credential: PT
Phone: 908-527-6001