Provider Demographics
NPI:1588733851
Name:THE CENTER FOR PHYSICAL MEDICINE AND REHABILITATION LLC
Entity type:Organization
Organization Name:THE CENTER FOR PHYSICAL MEDICINE AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-219-6501
Mailing Address - Street 1:776 SHREWSBURY AVE
Mailing Address - Street 2:STE. 203
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3006
Mailing Address - Country:US
Mailing Address - Phone:732-219-0333
Mailing Address - Fax:732-219-6526
Practice Address - Street 1:776 SHREWSBURY AVE
Practice Address - Street 2:STE. 203
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3006
Practice Address - Country:US
Practice Address - Phone:732-219-0333
Practice Address - Fax:732-219-6526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62353208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0778591OtherJB CIGNA
P00210688OtherJB RR M'CARE
NJ1K0329OtherJB HEALTHNET
6012036OtherJB GHI
NJF12448OtherDF HEALTHNET
2598116OtherDF GHI
5770149OtherDF AETNA
26Z741OtherJB EMPIRE
P1947080OtherJB OXFORD
5218141OtherJB AETNA
0674631OtherDF CIGNA
P1947080OtherJB OXFORD
2598116OtherDF GHI
0778591OtherJB CIGNA
P00210688OtherJB RR M'CARE
P1947080OtherJB OXFORD
26Z741OtherJB EMPIRE
FO795822Medicare ID - Type UnspecifiedDF
BA795753Medicare ID - Type UnspecifiedJB