Provider Demographics
NPI:1427008911
Name:COMPLETE REHAB THERAPY P C
Entity Type:Organization
Organization Name:COMPLETE REHAB THERAPY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOOKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-743-7090
Mailing Address - Street 1:540 BORDENTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 BORDENTOWN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1544
Practice Address - Country:US
Practice Address - Phone:718-743-7090
Practice Address - Fax:718-743-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00142400208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY087333Medicare PIN
Q35358Medicare UPIN
Y25989Medicare UPIN