Healthcare Provider Details

I. General information

NPI: 1285300665
Provider Name (Legal Business Name): TRINITY REHAB SOMERSET PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 W PLEASANTVIEW AVE
HACKENSACK NJ
07601-8005
US

IV. Provider business mailing address

554 HIGHWAY 35
RED BANK NJ
07701-5066
US

V. Phone/Fax

Practice location:
  • Phone: 732-219-5700
  • Fax:
Mailing address:
  • Phone: 732-219-5700
  • Fax: 732-334-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TONYA GAVRIELIDES
Title or Position: AO
Credential:
Phone: 732-219-5700