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General NPI Number Information
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NPI Number | 1326378894
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Entity Type | Organization
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Legal Business Name | JERSEY MEDICAL AND REHABILITATION GROUP PA.
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 477 RAHWAY AVE
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3481
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Country | US
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Telephone | 732-596-0660
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Fax | 732-596-0066
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Provider Business Mailing Address
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Address Line | 477 RAHWAY AVE
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3481
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Country | US
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Telephone | 732-596-0660
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Fax | 732-596-0066
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP C POLLEN
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Credential | M.D.
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Telephone | 732-596-0660
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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 | 25MA04642400
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License Number State | NJ
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