Provider Demographics
NPI:1063450963
Name:CROWN REHAB INC.
Entity Type:Organization
Organization Name:CROWN REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADEBUSOLA
Authorized Official - Middle Name:OLUWATOYIN
Authorized Official - Last Name:OYEFESO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:732-583-8630
Mailing Address - Street 1:205 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3127
Mailing Address - Country:US
Mailing Address - Phone:732-583-8630
Mailing Address - Fax:732-583-7650
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3127
Practice Address - Country:US
Practice Address - Phone:732-583-8630
Practice Address - Fax:732-583-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ316584Medicare ID - Type UnspecifiedCERT.OUTPATIENT REHAB FAC