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General NPI Number Information
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NPI Number | 1790166171
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Entity Type | Organization
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Legal Business Name | UNIVERSAL REHABILITATION & FITNESS INC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 8 ELLISON AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1706
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Country | US
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Telephone | 973-699-9941
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Fax |
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Provider Business Mailing Address
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Address Line | 15 MICROLAB RD SUITE 101
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1623
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Country | US
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Telephone | 973-992-8181
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Fax | 973-992-7178
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | MR. MICHAEL SCUDILLO
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Credential |
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Telephone | 973-992-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | NJ
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