Provider Demographics
NPI:1083915607
Name:REHABILITATION AND ELECTRODIAGNOSTICS INC
Entity Type:Organization
Organization Name:REHABILITATION AND ELECTRODIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCYNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LUPICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-553-1000
Mailing Address - Street 1:200 PERRINE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2842
Mailing Address - Country:US
Mailing Address - Phone:732-553-1000
Mailing Address - Fax:732-553-1003
Practice Address - Street 1:200 PERRINE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2842
Practice Address - Country:US
Practice Address - Phone:732-553-1000
Practice Address - Fax:732-553-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06710600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLU010092Medicare PIN