Healthcare Provider Details

I. General information

NPI: 1417278003
Provider Name (Legal Business Name): FIRST REHAB GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1352 RIVER AVE STE 3
LAKEWOOD NJ
08701-5646
US

IV. Provider business mailing address

282D CEDAR BRIDGE AVENUE
LAKEWOOD NJ
08701-4265
US

V. Phone/Fax

Practice location:
  • Phone: 732-987-5122
  • Fax:
Mailing address:
  • Phone: 732-987-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BARUCH GOTTLIEB
Title or Position: DIRECTOR
Credential:
Phone: 718-781-4703