Provider Demographics
NPI:1164123105
Name:BRIDGEWAY REHABILITATION SERVICES
Entity Type:Organization
Organization Name:BRIDGEWAY REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ-HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-469-6517
Mailing Address - Street 1:373 CLERMONT TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8073
Mailing Address - Country:US
Mailing Address - Phone:908-355-7886
Mailing Address - Fax:908-355-6668
Practice Address - Street 1:373 CLERMONT TER
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8073
Practice Address - Country:US
Practice Address - Phone:908-355-7886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0403873Medicaid