MEDICARE: INDEPENDENCE REHAB SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	525894	OTHER	NJ	AETNA USHEALTHCARE
2	316628	OTHER	NJ	HORIZON BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053366690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE REHAB SERVICES PC

Provider Business Mailing Address
First Line	:	1030 KINGS HWY N
Second Line	:	SUITE 210
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1907
Country	:	US
Telephone Number	:	856-321-1900
Fax Number	:	856-321-1107

Provider Business Practice Location Address
First Line	:	1030 KINGS HWY N
Second Line	:	SUITE 210
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1907
Country	:	US
Telephone Number	:	856-321-1900
Fax Number	:	856-321-1107

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MRS. SHIRVELL M THOMAS
Credential	:
Telephone Number	:	856-321-1900

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	03/03/2011

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