Provider Demographics
NPI:1346354495
Name:ADVANCED REHABILITATION OF WEST JERSEY, PC
Entity Type:Organization
Organization Name:ADVANCED REHABILITATION OF WEST JERSEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:KRISANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-213-9000
Mailing Address - Street 1:538 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-3942
Mailing Address - Country:US
Mailing Address - Phone:908-213-9000
Mailing Address - Fax:908-213-9002
Practice Address - Street 1:538 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-3942
Practice Address - Country:US
Practice Address - Phone:908-213-9000
Practice Address - Fax:908-213-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC3814111N00000X
NJ40QA01122700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ021591Medicare ID - Type Unspecified