Provider Demographics
NPI:1255472551
Name:CONCORD HEALTH & REHABILITATION, INC.
Entity Type:Organization
Organization Name:CONCORD HEALTH & REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DESMOND
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC PT
Authorized Official - Phone:856-910-0495
Mailing Address - Street 1:107 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2038
Mailing Address - Country:US
Mailing Address - Phone:856-910-0495
Mailing Address - Fax:856-665-5731
Practice Address - Street 1:107 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109
Practice Address - Country:US
Practice Address - Phone:856-910-0495
Practice Address - Fax:856-665-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4699111N00000X
NJ01496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U60465Medicare UPIN
449998Medicare ID - Type Unspecified