MEDICARE: EIKEV REHAB LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1073984605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EIKEV REHAB LLC

Provider Business Mailing Address
First Line	:	1539 ROCKAWAY RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3931
Country	:	US
Telephone Number	:	347-439-8641
Fax Number	:	732-377-5140

Provider Business Practice Location Address
First Line	:	1539 ROCKAWAY RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3931
Country	:	US
Telephone Number	:	347-439-8641
Fax Number	:	732-377-5140

Authorized Official
Title or Position	:	OWNER
Name	:	CHANA POLLAK
Credential	:
Telephone Number	:	347-439-8641

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	10/08/2015

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Directions to “EIKEV REHAB LLC ” Practice Location

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