Healthcare Provider Details

I. General information

NPI: 1477580744
Provider Name (Legal Business Name): PRESTIGE MEDICAL & REHABILITATION CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E RIDGEWOOD AVE STE 4
PARAMUS NJ
07652-3625
US

IV. Provider business mailing address

80 E RIDGEWOOD AVE STE 4
PARAMUS NJ
07652-3625
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-5000
  • Fax: 201-265-5003
Mailing address:
  • Phone: 201-265-5000
  • Fax: 201-265-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA0726200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00873600
License Number StateNJ

VIII. Authorized Official

Name: DANA B GELLIS
Title or Position: PRESIDENT
Credential: MD
Phone: 201-265-5000