Provider Demographics
NPI:1285789909
Name:REHABILITATION PHYSICIANS OF SOUTH JERSEY LLC
Entity type:Organization
Organization Name:REHABILITATION PHYSICIANS OF SOUTH JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-896-2008
Mailing Address - Street 1:1237 W SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6920
Mailing Address - Country:US
Mailing Address - Phone:856-696-7100
Mailing Address - Fax:856-696-3065
Practice Address - Street 1:1237 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6920
Practice Address - Country:US
Practice Address - Phone:856-696-7100
Practice Address - Fax:856-696-3065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0094072Medicaid
NJ091582Medicare ID - Type Unspecified