Provider Demographics
NPI:1235463423
Name:PEDIATRIC REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:PEDIATRIC REHABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADUANO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:732-279-0600
Mailing Address - Street 1:254 BRICK BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7170
Mailing Address - Country:US
Mailing Address - Phone:732-279-0600
Mailing Address - Fax:732-255-5095
Practice Address - Street 1:254 BRICK BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7170
Practice Address - Country:US
Practice Address - Phone:732-279-0600
Practice Address - Fax:732-255-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00108000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty