Provider Demographics
NPI:1326199084
Name:FIRST REHAB SOUTH AMBOY LLC
Entity type:Organization
Organization Name:FIRST REHAB SOUTH AMBOY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YAAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-886-1900
Mailing Address - Street 1:4557 US HIGHWAY 9
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3382
Mailing Address - Country:US
Mailing Address - Phone:732-886-1900
Mailing Address - Fax:732-886-1950
Practice Address - Street 1:404 MAIN ST
Practice Address - Street 2:SITE A
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1794
Practice Address - Country:US
Practice Address - Phone:732-254-1990
Practice Address - Fax:732-254-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ316708Medicare ID - Type UnspecifiedOUTPATIENT THERAPY