Provider Demographics
NPI:1063964609
Name:NEXTGEN REHAB LLC
Entity type:Organization
Organization Name:NEXTGEN REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-277-5985
Mailing Address - Street 1:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-1225
Mailing Address - Country:US
Mailing Address - Phone:586-277-5985
Mailing Address - Fax:800-836-9340
Practice Address - Street 1:13530 MICHIGAN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3574
Practice Address - Country:US
Practice Address - Phone:586-277-5985
Practice Address - Fax:800-836-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty