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General NPI Number Information
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NPI Number | 1548531015
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Entity Type | Organization
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Legal Business Name | DONNELLY REHABILITATION SERVICES
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 395 CLAREMONT AVE #2
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City | MONTCLAIR
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State | NJ
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Zip | 07042-1879
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Country | US
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Telephone | 609-529-7194
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Fax |
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Provider Business Mailing Address
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Address Line | 41 WATCHUNG PLZ #346
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4117
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Country | US
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Telephone | 862-596-2989
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAMES VINCENT DONNELLY
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Credential | OT
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Telephone | 609-529-7194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 46TR00329400
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License Number State | NJ
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