Provider Demographics
NPI:1609811470
Name:CLARK REHAB SERVICES LLC
Entity Type:Organization
Organization Name:CLARK REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DELL'AQUILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-382-2473
Mailing Address - Street 1:36 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2908
Mailing Address - Country:US
Mailing Address - Phone:732-388-8333
Mailing Address - Fax:732-388-9444
Practice Address - Street 1:53 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-3262
Practice Address - Country:US
Practice Address - Phone:732-388-8333
Practice Address - Fax:732-388-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA011887-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ048728Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #