Provider Demographics
NPI:1083911507
Name:ZMA REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:ZMA REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BURT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LACIVITA
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR
Authorized Official - Phone:201-923-7533
Mailing Address - Street 1:141 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2609
Mailing Address - Country:US
Mailing Address - Phone:201-923-7533
Mailing Address - Fax:
Practice Address - Street 1:81 NORTHFIELD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5342
Practice Address - Country:US
Practice Address - Phone:973-325-0229
Practice Address - Fax:973-325-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00395600261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)