Healthcare Provider Details

I. General information

NPI: 1174126387
Provider Name (Legal Business Name): TRINITY REHAB SOMERSET PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NORTH MAIN STREET STORE 14
DOYLESTOWN PA
18901
US

IV. Provider business mailing address

554 HIGHWAY 35
RED BANK NJ
07701-5066
US

V. Phone/Fax

Practice location:
  • Phone: 732-219-5700
  • Fax: 732-334-3004
Mailing address:
  • Phone: 173-221-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1245789064
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerBCBS

VIII. Authorized Official

Name: TONYA GAVRIELIDES
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-219-5700