Provider Demographics
NPI:1124610795
Name:COMPLETE PHYSICAL REHABILITATION AND DIAGNOSTICS
Entity type:Organization
Organization Name:COMPLETE PHYSICAL REHABILITATION AND DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PUMARADA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:908-591-2474
Mailing Address - Street 1:240 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1132
Mailing Address - Country:US
Mailing Address - Phone:908-591-2474
Mailing Address - Fax:
Practice Address - Street 1:701 NEWARK AVE STE 212
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3560
Practice Address - Country:US
Practice Address - Phone:908-527-6001
Practice Address - Fax:908-527-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy