Provider Demographics
NPI:1609268580
Name:BRIDGEWAY REHABILITATION SERVICES
Entity Type:Organization
Organization Name:BRIDGEWAY REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ-HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-355-7886
Mailing Address - Street 1:615 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3409
Mailing Address - Country:US
Mailing Address - Phone:908-355-7886
Mailing Address - Fax:908-355-6668
Practice Address - Street 1:554 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 201, 2ND FLOOR
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3307
Practice Address - Country:US
Practice Address - Phone:908-355-7886
Practice Address - Fax:908-355-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ204010248251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management