Provider Demographics
NPI:1568436111
Name:ATLANTIC PHYSICAL MEDICINE & REHABILITATION CENTER P A
Entity Type:Organization
Organization Name:ATLANTIC PHYSICAL MEDICINE & REHABILITATION CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBASHIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-736-0100
Mailing Address - Street 1:9 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE C-25
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6425
Mailing Address - Country:US
Mailing Address - Phone:732-736-0100
Mailing Address - Fax:732-736-0666
Practice Address - Street 1:9 HOSPITAL DRIVE
Practice Address - Street 2:SUITE C-25
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6425
Practice Address - Country:US
Practice Address - Phone:732-736-0100
Practice Address - Fax:732-736-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8370800Medicaid
NJCJ2446OtherRAIL ROAD MEDICARE
NJ8370800Medicaid