Healthcare Provider Details

I. General information

NPI: 1265563738
Provider Name (Legal Business Name): JERSEY REHAB PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3146 E TREMONT AVE
BRONX NY
10461-5706
US

IV. Provider business mailing address

15 NEWARK AVE
BELLEVILLE NJ
07109-1123
US

V. Phone/Fax

Practice location:
  • Phone: 718-792-6503
  • Fax: 718-792-0096
Mailing address:
  • Phone: 973-482-1614
  • Fax: 973-485-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA178991-2
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA178991-2
License Number StateNY

VIII. Authorized Official

Name: ROBERT A. MARINI
Title or Position: MD
Credential: MD
Phone: 973-482-1614