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General NPI Number Information
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NPI Number | 1124368477
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Entity Type | Organization
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Legal Business Name | VISTA REHAB SERVICES
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 185 GREEN STREET
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City | WOODBRIDGE
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State | NJ
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Zip | 07095
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Country | US
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Telephone | 732-634-5980
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Fax | 732-634-9508
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Provider Business Mailing Address
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Address Line | 185 GREEN STREET
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City | WOODBRIDGE
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State | NJ
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Zip | 07095
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Country | US
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Telephone | 732-634-5980
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Fax | 732-634-9508
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Authorized Official
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Title or Position | DIRECTOR
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Name | KATHLEEN B MCEWEN
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Credential | MSCCC-SLP
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Telephone | 732-634-5980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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