MEDICARE: UNIVERSAL REHABILITATION & FITNESS CENTER INC

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649651746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL REHABILITATION & FITNESS CENTER INC

Provider Business Mailing Address
First Line	:	15 MICROLAB RD
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1623
Country	:	US
Telephone Number	:	973-992-8181
Fax Number	:	973-992-7178

Provider Business Practice Location Address
First Line	:	73B DUDLEY ST
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5956
Country	:	US
Telephone Number	:	732-963-9446
Fax Number	:	732-272-1574

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	MR. MICHAEL SCUDILLO
Credential	:
Telephone Number	:	973-992-8181

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	12/01/2015

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