Healthcare Provider Details

I. General information

NPI: 1679650790
Provider Name (Legal Business Name): FOREST HILL REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MT PROSPECT AVE.
NEWARK NJ
07104
US

IV. Provider business mailing address

465 MT PROSPECT AVE.
NEWARK NJ
07104
US

V. Phone/Fax

Practice location:
  • Phone: 973-485-4766
  • Fax: 973-732-1141
Mailing address:
  • Phone: 973-485-4766
  • Fax: 973-732-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA00334600
License Number StateNJ

VIII. Authorized Official

Name: MR. MARVIN P. ROYAL II
Title or Position: CLINICAL DIRECTOR
Credential: MD
Phone: 973-485-4766