Provider Demographics
NPI:1558454702
Name:NEW JERSEY REHAB AND ELECTRODIAGNOSTICS PA
Entity Type:Organization
Organization Name:NEW JERSEY REHAB AND ELECTRODIAGNOSTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJU
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-429-7799
Mailing Address - Street 1:120 OLD CAMPLAIN RD STE 2H
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4394
Mailing Address - Country:US
Mailing Address - Phone:908-429-7799
Mailing Address - Fax:866-611-9616
Practice Address - Street 1:120 OLD CAMPLAIN RD STE 2H
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4394
Practice Address - Country:US
Practice Address - Phone:908-429-7799
Practice Address - Fax:866-611-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ055890Medicare PIN