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General NPI Number Information
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NPI Number | 1578517991
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE AND REHABILITATION CENTER, PA
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 500 GRAND AVE FIRST FLOOR
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4967
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Country | US
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Telephone | 201-567-2277
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Fax | 201-567-2639
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Provider Business Mailing Address
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Address Line | 500 GRAND AVE FIRST FLOOR
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4967
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Country | US
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Telephone | 201-567-2277
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Fax | 201-567-2639
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Authorized Official
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Title or Position | DOCTOR OF OSTEOPATHIC MEDICINE
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Name | DR. SHERRY S GHOSH
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Credential | D.O
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Telephone | 201-567-2277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MB07455100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MB07455100
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License Number State | NJ
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