Provider Demographics
NPI:1326100413
Name:NORTHERN REHAB INC.
Entity Type:Organization
Organization Name:NORTHERN REHAB INC.
Other - Org Name:NORTHERN REHABILITATION AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKEEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-790-9010
Mailing Address - Street 1:401 HAMBURG TPKE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2154
Mailing Address - Country:US
Mailing Address - Phone:973-790-9010
Mailing Address - Fax:973-790-9050
Practice Address - Street 1:401 HAMBURG TPKE
Practice Address - Street 2:SUITE 204
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2154
Practice Address - Country:US
Practice Address - Phone:973-790-9010
Practice Address - Fax:973-790-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00347900225100000X
NJ46TR00404000225X00000X
NJ41YS00463300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31-6554Medicare ID - Type UnspecifiedCORA