Provider Demographics
NPI:1235476433
Name:UNION COUNTY COMPREHENSIVE MEDICAL AND REHABILITATION CENTER, PC
Entity Type:Organization
Organization Name:UNION COUNTY COMPREHENSIVE MEDICAL AND REHABILITATION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-351-6060
Mailing Address - Street 1:469 MORRIS AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-2904
Mailing Address - Country:US
Mailing Address - Phone:908-351-6060
Mailing Address - Fax:908-351-5330
Practice Address - Street 1:469 MORRIS AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2904
Practice Address - Country:US
Practice Address - Phone:908-351-6060
Practice Address - Fax:908-351-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA049364002081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Single Specialty