Provider Demographics
NPI:1275732562
Name:OMNI CARE REHABILITATION
Entity Type:Organization
Organization Name:OMNI CARE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEWALE
Authorized Official - Middle Name:TAIWO
Authorized Official - Last Name:ADESINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:908-303-8514
Mailing Address - Street 1:48 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5647
Mailing Address - Country:US
Mailing Address - Phone:908-303-8514
Mailing Address - Fax:908-979-9797
Practice Address - Street 1:25 CRAIG PL
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-4777
Practice Address - Country:US
Practice Address - Phone:908-303-8514
Practice Address - Fax:908-979-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00661400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
026244Medicare PIN