MEDICARE: GENESIS REHAB SERVICES

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	314000000X	Skilled Nursing Facility	46TA09088300	NJ

General Provider Information

NPI Number	:	1174990790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS REHAB SERVICES

Provider Business Mailing Address
First Line	:	404 CHASE CT
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1609
Country	:	US
Telephone Number	:	845-416-2699
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 CHASE CT
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1609
Country	:	US
Telephone Number	:	845-416-2699
Fax Number	:

Authorized Official
Title or Position	:	COTA
Name	:	MRS. EMILY JANE PERROTTA
Credential	:
Telephone Number	:	845-416-2699

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	08/31/2015

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