Provider Demographics
NPI:1063746527
Name:ACCELERATED REHAB & PAIN MANAGEMENT PA
Entity type:Organization
Organization Name:ACCELERATED REHAB & PAIN MANAGEMENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-794-4704
Mailing Address - Street 1:PO BOX 4405
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-8405
Mailing Address - Country:US
Mailing Address - Phone:973-794-4704
Mailing Address - Fax:973-794-4707
Practice Address - Street 1:1279 ROUTE 46
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4904
Practice Address - Country:US
Practice Address - Phone:973-794-4704
Practice Address - Fax:973-794-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07658100207QA0401X, 208100000X, 208VP0000X, 208VP0014X
NY235083207QA0401X, 208VP0000X, 208VP0014X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081739Medicare PIN