Provider Demographics
NPI:1093834319
Name:CROTTY REHABILITATION LLC
Entity Type:Organization
Organization Name:CROTTY REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:CROTTY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:609-351-3954
Mailing Address - Street 1:44 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-9550
Mailing Address - Country:US
Mailing Address - Phone:609-351-3954
Mailing Address - Fax:609-372-4519
Practice Address - Street 1:44 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-9550
Practice Address - Country:US
Practice Address - Phone:609-351-3954
Practice Address - Fax:609-372-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00730100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255354692OtherNATIONAL PROVIDER IDENTIF
NJ112386OtherMEDICARE PROVIDER NUMBER
158728409OtherSOCIAL SECURITY NUMBER