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General NPI Number Information
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NPI Number | 1417228917
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Entity Type | Organization
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Legal Business Name | EAST COAST REHABILITATION SERVICES LLC
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 700 FAIRFIELD AVE
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City | KENILWORTH
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State | NJ
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Zip | 07033-2012
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Country | US
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Telephone | 908-241-8591
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Fax | 855-631-4348
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Provider Business Mailing Address
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Address Line | 700 FAIRFIELD AVE
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City | KENILWORTH
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State | NJ
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Zip | 07033-2012
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Country | US
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Telephone | 908-241-8591
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Fax | 855-631-4348
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Authorized Official
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Title or Position | CO-OWNER
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Name | MARIA NISPEROS
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Credential | PT
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Telephone | 973-704-7734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA01110500
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License Number State | NJ
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