Provider Demographics
NPI:1326117029
Name:NORTHERN NEW JERSEY PAIN AND REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:NORTHERN NEW JERSEY PAIN AND REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SARA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:201-262-2244
Mailing Address - Street 1:37 W CENTURY RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1409
Mailing Address - Country:US
Mailing Address - Phone:201-262-2244
Mailing Address - Fax:201-262-2246
Practice Address - Street 1:37 W CENTURY RD
Practice Address - Street 2:SUITE: 111
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1409
Practice Address - Country:US
Practice Address - Phone:201-262-2244
Practice Address - Fax:201-262-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22850261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ314511Medicare PIN