Healthcare Provider Details

I. General information

NPI: 1346354495
Provider Name (Legal Business Name): ADVANCED REHABILITATION OF WEST JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 NEW BRUNSWICK AVE
PHILLIPSBURG NJ
08865-3942
US

IV. Provider business mailing address

538 NEW BRUNSWICK AVE
PHILLIPSBURG NJ
08865-3942
US

V. Phone/Fax

Practice location:
  • Phone: 908-213-9000
  • Fax: 908-213-9002
Mailing address:
  • Phone: 908-213-9000
  • Fax: 908-213-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC3814
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01122700
License Number StateNJ

VIII. Authorized Official

Name: DR. SCOTT BRIAN KRISANDA
Title or Position: DOCTOR
Credential: DC
Phone: 908-213-9000