Provider Demographics
NPI:1093075160
Name:FORT LEE REHABILITATION
Entity Type:Organization
Organization Name:FORT LEE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-592-6200
Mailing Address - Street 1:530 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4506
Mailing Address - Country:US
Mailing Address - Phone:201-592-6200
Mailing Address - Fax:201-592-6401
Practice Address - Street 1:530 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4506
Practice Address - Country:US
Practice Address - Phone:201-592-6200
Practice Address - Fax:201-592-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJMCO1411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty