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General NPI Number Information
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NPI Number | 1073902904
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Entity Type | Organization
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Legal Business Name | BERGEN HAND REHABILITATION, LLC
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 106 GRAND AVENUE SUITE 420
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City | ENGLEWOOD
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State | NJ
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Zip | 07631
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Country | US
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Telephone | 201-569-2229
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Fax | 201-569-2239
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Provider Business Mailing Address
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Address Line | 106 GRAND AVE SUITE 420
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3574
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Country | US
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Telephone | 201-569-2229
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Fax | 201-569-2239
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. DEBORAH CHILELLI-BORU
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Credential | MA, ORT/L, CHT
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Telephone | 201-569-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 46TR00366000
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License Number State | NJ
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