Provider Demographics
NPI:1316279292
Name:MODERN REHABILITATION TECHNOLOGIES, LLC
Entity type:Organization
Organization Name:MODERN REHABILITATION TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHWING
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, CPO
Authorized Official - Phone:973-784-4286
Mailing Address - Street 1:329 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2821
Mailing Address - Country:US
Mailing Address - Phone:631-360-6400
Mailing Address - Fax:631-360-6449
Practice Address - Street 1:431 E MAIN STREET (ROUTE 53)
Practice Address - Street 2:SUITE 2
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-784-4286
Practice Address - Fax:973-784-4287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00011500335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0233897Medicaid
NJ0233897Medicaid