Provider Demographics
NPI:1316230279
Name:ADVANCED COMMUNITY REHABILITATION
Entity Type:Organization
Organization Name:ADVANCED COMMUNITY REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:IZUNDU
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-416-4800
Mailing Address - Street 1:40 UNION AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3290
Mailing Address - Country:US
Mailing Address - Phone:973-416-4800
Mailing Address - Fax:
Practice Address - Street 1:40 UNION AVE STE 304
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3290
Practice Address - Country:US
Practice Address - Phone:973-416-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00590500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty