Provider Demographics
NPI:1932565983
Name:PALISADES REHAB AND PHYSICAL THERAPY CENTER, LLC
Entity type:Organization
Organization Name:PALISADES REHAB AND PHYSICAL THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN-CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-941-3939
Mailing Address - Street 1:596 ANDERSON AVE
Mailing Address - Street 2:108
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1831
Mailing Address - Country:US
Mailing Address - Phone:201-941-3939
Mailing Address - Fax:
Practice Address - Street 1:596 ANDERSON AVE
Practice Address - Street 2:108
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1831
Practice Address - Country:US
Practice Address - Phone:201-941-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01109800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ423843OtherMEDICARE ID