MEDICARE: PARAMOUNT REHABILITATION 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	208100000X	Physical Medicine & Rehabilitation Physician	40QA01528100	NJ

General Provider Information

NPI Number	:	1548634652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAMOUNT REHABILITATION LLC

Provider Business Mailing Address
First Line	:	16-00 ROUTE 208 SOUTH
Second Line	:	SUITE 204
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-2503
Country	:	US
Telephone Number	:	201-880-6207
Fax Number	:	201-880-6208

Provider Business Practice Location Address
First Line	:	16-00 ROUTE 208 SOUTH
Second Line	:	SUITE 204
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-2503
Country	:	US
Telephone Number	:	201-880-6207
Fax Number	:	201-880-6208

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	DR. EUGENE GORDON
Credential	:	PT, DPT
Telephone Number	:	201-880-6207

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	03/02/2020

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