Healthcare Provider Details

I. General information

NPI: 1285980912
Provider Name (Legal Business Name): FAMILY NEUROLOGY & REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 VALLEY BROOK AVE STE 2
LYNDHURST NJ
07071-1919
US

IV. Provider business mailing address

576 VALLEY BROOK AVE STE 2
LYNDHURST NJ
07071-1919
US

V. Phone/Fax

Practice location:
  • Phone: 201-933-5450
  • Fax: 201-933-5452
Mailing address:
  • Phone: 201-933-5450
  • Fax: 201-933-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DAVID HARRIS
Title or Position: MANAGING MEMBER
Credential: DC
Phone: 201-933-5450