Provider Demographics
NPI:1366686610
Name:NEWARK REHABILITATION CENTER PA
Entity Type:Organization
Organization Name:NEWARK REHABILITATION CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:F
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-481-4040
Mailing Address - Street 1:638 MOUNT PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-3110
Mailing Address - Country:US
Mailing Address - Phone:973-481-4040
Mailing Address - Fax:973-481-1338
Practice Address - Street 1:638 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3110
Practice Address - Country:US
Practice Address - Phone:973-481-4040
Practice Address - Fax:973-481-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36270208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty