MEDICARE: NORTH JERSEY PROFESSIONAL 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	225100000X	Physical Therapist	40QA00640100	NJ

General Provider Information

NPI Number	:	1992848329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH JERSEY PROFESSIONAL REHABILITATION LLC

Provider Business Mailing Address
First Line	:	122 NORTH CHURCH RD
Second Line	:	LOWER LEVEL
City	:	SPARTA
State	:	NJ
Zip	:	07871-3234
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	:	LOWER LEVEL
City	:	SPARTA
State	:	NJ
Zip	:	07871-3234
Country	:	US
Telephone Number	:	973-940-8910
Fax Number	:	973-940-8918

Authorized Official
Title or Position	:	PHYSICAL THERAPIST, MEMBER
Name	:	MR. CHRISTOPHER HAYDEN
Credential	:	M.A., PT, OCS
Telephone Number	:	973-940-8910

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	10/02/2012

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