Healthcare Provider Details

I. General information

NPI: 1326117029
Provider Name (Legal Business Name): NORTHERN NEW JERSEY PAIN AND REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W CENTURY RD SUITE: 111
PARAMUS NJ
07652-1409
US

IV. Provider business mailing address

37 W CENTURY RD SUITE 111
PARAMUS NJ
07652-1409
US

V. Phone/Fax

Practice location:
  • Phone: 201-262-2244
  • Fax: 201-262-2246
Mailing address:
  • Phone: 201-262-2244
  • Fax: 201-262-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number22850
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. CHARLES A SARA
Title or Position: ADMINISTRATOR
Credential: M.S.
Phone: 201-262-2244