Provider Demographics
NPI:1578517991
Name:PHYSICAL MEDICINE AND REHABILITATION CENTER, PA
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE AND REHABILITATION CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OSTEOPATHIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GHOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-567-2277
Mailing Address - Street 1:500 GRAND AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4967
Mailing Address - Country:US
Mailing Address - Phone:201-567-2277
Mailing Address - Fax:201-567-2639
Practice Address - Street 1:500 GRAND AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4967
Practice Address - Country:US
Practice Address - Phone:201-567-2277
Practice Address - Fax:201-567-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07455100174400000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI23762Medicare UPIN