MEDICARE: NORTH JERSEY PRO REHAB

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	261QP2000X	Physical Therapy Clinic/Center	40QB00088500	NJ

General Provider Information

NPI Number	:	1255640496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH JERSEY PRO REHAB

Provider Business Mailing Address
First Line	:	122 NORTH CHURCH RD.
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-0000
Country	:	US
Telephone Number	:	973-940-8910
Fax Number	:	973-940-8918

Provider Business Practice Location Address
First Line	:	122 NORTH CHURCH RD.
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-0000
Country	:	US
Telephone Number	:	973-940-8910
Fax Number	:	973-940-8918

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHRISTOPHER HAYDEN
Credential	:	P.T.
Telephone Number	:	973-940-8910

Provider Enumeration Date	:	10/06/2010
Last Update Date	:	10/06/2010

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Directions to “NORTH JERSEY PRO REHAB ” Practice Location

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