MEDICARE: ESSEX REHABILITATION, P.C.

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

General Provider Information

NPI Number	:	1568640274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSEX REHABILITATION, P.C.

Provider Business Mailing Address
First Line	:	280 SOUTH HARRISON STREET
Second Line	:	SUITE 215
City	:	EAST ORANGE
State	:	NJ
Zip	:	07018-1305
Country	:	US
Telephone Number	:	973-674-5511
Fax Number	:	973-674-4499

Provider Business Practice Location Address
First Line	:	280 SOUTH HARRISON STREET
Second Line	:	SUITE 215
City	:	EAST ORANGE
State	:	NJ
Zip	:	07018-1305
Country	:	US
Telephone Number	:	973-674-5511
Fax Number	:	973-674-4499

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VADIM SURIKOV
Credential	:	DO
Telephone Number	:	973-674-5511

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/05/2008

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