Provider Demographics
NPI:1073902904
Name:BERGEN HAND REHABILITATION, LLC
Entity Type:Organization
Organization Name:BERGEN HAND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILELLI-BORU
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ORT/L, CHT
Authorized Official - Phone:201-569-2229
Mailing Address - Street 1:106 GRAND AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3574
Mailing Address - Country:US
Mailing Address - Phone:201-569-2229
Mailing Address - Fax:201-569-2239
Practice Address - Street 1:106 GRAND AVENUE
Practice Address - Street 2:SUITE 420
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-569-2229
Practice Address - Fax:201-569-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00366000225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty