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General NPI Number Information
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NPI Number | 1316086382
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Entity Type | Organization
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Legal Business Name | TRICOUNTY NEUROLOGY & REHABILITATION
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 86 PLYMOUTH ST
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City | FAIRFIELD
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State | NJ
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Zip | 07004-1605
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Country | US
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Telephone | 973-227-7105
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Fax | 973-882-8950
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Provider Business Mailing Address
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Address Line | 86 PLYMOUTH ST
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City | FAIRFIELD
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State | NJ
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Zip | 07004-1605
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Country | US
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Telephone | 973-227-7105
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LUCILLE KIM LA MORTE
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Credential |
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Telephone | 973-227-7105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA45384
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License Number State | NJ
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