Provider Demographics
NPI:1346570306
Name:BRIDGEWAY REHABILITATION SERVICES
Entity Type:Organization
Organization Name:BRIDGEWAY REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ-HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-355-7886
Mailing Address - Street 1:615 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3409
Mailing Address - Country:US
Mailing Address - Phone:908-355-7886
Mailing Address - Fax:908-355-6668
Practice Address - Street 1:93 STICKLES POND RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2813
Practice Address - Country:US
Practice Address - Phone:973-383-8690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20401-20-05251B00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management