Provider Demographics
NPI:1316086382
Name:TRICOUNTY NEUROLOGY & REHABILITATION
Entity type:Organization
Organization Name:TRICOUNTY NEUROLOGY & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:LA MORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-227-7105
Mailing Address - Street 1:86 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1605
Mailing Address - Country:US
Mailing Address - Phone:973-227-7105
Mailing Address - Fax:
Practice Address - Street 1:86 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1605
Practice Address - Country:US
Practice Address - Phone:973-227-7105
Practice Address - Fax:973-882-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA45384174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty