Healthcare Provider Details

I. General information

NPI: 1780930834
Provider Name (Legal Business Name): RED BANK NEUROREHABILITATION ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 RECKLESS PL
RED BANK NJ
07701-1704
US

IV. Provider business mailing address

12 RECKLESS PL
RED BANK NJ
07701-1704
US

V. Phone/Fax

Practice location:
  • Phone: 908-692-9485
  • Fax:
Mailing address:
  • Phone: 908-692-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH MARCANTUONO
Title or Position: CLINICAL PSYCHOLOGIST/PARTNER
Credential: PH.D.
Phone: 908-692-9485