Healthcare Provider Details

I. General information

NPI: 1184703738
Provider Name (Legal Business Name): CENTER FOR COGNITIVE REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 RIVER RD
FAIR HAVEN NJ
07704
US

IV. Provider business mailing address

403 RIVER RD
FAIR HAVEN NJ
07704
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-6729
  • Fax: 732-842-7901
Mailing address:
  • Phone: 732-842-6729
  • Fax: 732-842-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMA29119
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN PAUL SWIDRYK
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 732-842-6729