Provider Demographics
NPI:1558684654
Name:SHEA REHABILITATION SERVICES,LLC
Entity Type:Organization
Organization Name:SHEA REHABILITATION SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-396-1332
Mailing Address - Street 1:11 ERIC RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2303
Mailing Address - Country:US
Mailing Address - Phone:201-396-1332
Mailing Address - Fax:
Practice Address - Street 1:11 ERIC RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2303
Practice Address - Country:US
Practice Address - Phone:201-396-1332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00198200171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty