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General NPI Number Information
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NPI Number | 1952852709
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Entity Type | Organization
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Legal Business Name | FIVE ELEMENT REHAB, LLC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 725 RIVER RD SUITE 201
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City | EDGEWATER
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State | NJ
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Zip | 07020-1171
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Country | US
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Telephone | 201-943-7768
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Fax | 201-943-7798
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Provider Business Mailing Address
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Address Line | 725 RIVER RD SUITE 201
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City | EDGEWATER
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State | NJ
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Zip | 07020-1171
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Country | US
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Telephone | 201-943-7768
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Fax | 201-943-7798
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Authorized Official
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Title or Position | OWNER
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Name | DR. EUGENE LEE
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Credential | D.C.
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Telephone | 201-943-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00636500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00353600
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License Number State | NJ
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