Provider Demographics
NPI:1043588569
Name:FERRY PAIN & REHAB CENTER
Entity Type:Organization
Organization Name:FERRY PAIN & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-344-0129
Mailing Address - Street 1:128 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2115
Mailing Address - Country:US
Mailing Address - Phone:973-344-0129
Mailing Address - Fax:973-344-0243
Practice Address - Street 1:128 FERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2115
Practice Address - Country:US
Practice Address - Phone:973-344-0129
Practice Address - Fax:973-344-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00508400261Q00000X
NJ38MC00235500261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU73135Medicare UPIN
NJ022086Medicare PIN
NJ194755Medicare PIN