Provider Demographics
NPI:1083973325
Name:PROFESSIONALS IN MEDICAL REHABILITATION LLC
Entity Type:Organization
Organization Name:PROFESSIONALS IN MEDICAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TALYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-757-3915
Mailing Address - Street 1:191 NORTH AVE
Mailing Address - Street 2:SUITE 395
Mailing Address - City:DUNELLEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1277
Mailing Address - Country:US
Mailing Address - Phone:908-757-3915
Mailing Address - Fax:
Practice Address - Street 1:191 NORTH AVE
Practice Address - Street 2:SUITE 395
Practice Address - City:DUNELLEN
Practice Address - State:NJ
Practice Address - Zip Code:08812-1277
Practice Address - Country:US
Practice Address - Phone:908-757-3915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty