Healthcare Provider Details

I. General information

NPI: 1487852737
Provider Name (Legal Business Name): ATLANTIC MEDICAL REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MOUNTAIN AVE
HACKETTSTOWN NJ
07840-2307
US

IV. Provider business mailing address

8 CARLISLE CT
CHESTER NJ
07930-2058
US

V. Phone/Fax

Practice location:
  • Phone: 908-852-1887
  • Fax: 908-852-0614
Mailing address:
  • Phone: 908-510-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number25MA05826300
License Number StateNJ

VIII. Authorized Official

Name: DR. VIPUL V SHAH
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 908-879-8202