Provider Demographics
NPI:1093741258
Name:TRINITY REHAB LLC
Entity Type:Organization
Organization Name:TRINITY REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:FABOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-219-5700
Mailing Address - Street 1:1016 STATE ROUTE 34
Mailing Address - Street 2:PINECREST PLAZA
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3476
Mailing Address - Country:US
Mailing Address - Phone:732-583-0085
Mailing Address - Fax:732-583-0089
Practice Address - Street 1:1016 STATE ROUTE 34
Practice Address - Street 2:PINECREST PLAZA
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3476
Practice Address - Country:US
Practice Address - Phone:732-583-0085
Practice Address - Fax:732-583-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00933600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6241650001Medicare NSC
NJ052365Medicare ID - Type Unspecified