Healthcare Provider Details

I. General information

NPI: 1477712263
Provider Name (Legal Business Name): CORE REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 STRONG PL
SOUTH PLAINFIELD NJ
07080-2620
US

IV. Provider business mailing address

118 STRONG PL
SOUTH PLAINFIELD NJ
07080-2620
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-6569
  • Fax:
Mailing address:
  • Phone: 908-755-6569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01118800
License Number StateNJ

VIII. Authorized Official

Name: CARLO MAGNO B DECASTRO
Title or Position: OWNER
Credential: PHYSICAL THERAPIST
Phone: 908-344-2084