Healthcare Provider Details

I. General information

NPI: 1831110469
Provider Name (Legal Business Name): PHYSICAL MEDICINE AND REHABILITATION CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GRAND AVE STE 100
ENGLEWOOD NJ
07631-4968
US

IV. Provider business mailing address

500 GRAND AVE STE 100
ENGLEWOOD NJ
07631-4968
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-2277
  • Fax:
Mailing address:
  • Phone: 201-567-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACY ISAACS-PINDUS
Title or Position: BILLING MANAGER
Credential:
Phone: 201-567-2277