Provider Demographics
NPI:1427274919
Name:HEALTHY BODY REHABILITATION PC
Entity type:Organization
Organization Name:HEALTHY BODY REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIKTORIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOMENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-617-9999
Mailing Address - Street 1:25 KILMER DR
Mailing Address - Street 2:BLDG. 3, SUITE 109
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1564
Mailing Address - Country:US
Mailing Address - Phone:732-617-9999
Mailing Address - Fax:732-617-1818
Practice Address - Street 1:25 KILMER DR
Practice Address - Street 2:BLDG. 3, SUITE 109
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1564
Practice Address - Country:US
Practice Address - Phone:732-617-9999
Practice Address - Fax:732-617-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1563396OtherAMERIHEALTH GROUP ID
NJ072080Medicare ID - Type Unspecified