MEDICARE: UNIVERSAL REHABILIATATION & 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

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	:	1740645548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL REHABILIATATION & FITNESS CENTER INC

Provider Business Mailing Address
First Line	:	15 MICROLAB RD STE 17
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1699
Country	:	US
Telephone Number	:	973-992-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 ARVERNE RD
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2647
Country	:	US
Telephone Number	:	973-731-7628
Fax Number	:

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

Provider Enumeration Date	:	12/21/2015
Last Update Date	:	12/21/2015

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