Provider Demographics
NPI:1619519980
Name:ADVANCED REHABILITATION OF HARRISON, LLC
Entity Type:Organization
Organization Name:ADVANCED REHABILITATION OF HARRISON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RENAUDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-260-3476
Mailing Address - Street 1:107 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1332
Mailing Address - Country:US
Mailing Address - Phone:862-505-1713
Mailing Address - Fax:
Practice Address - Street 1:107 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1332
Practice Address - Country:US
Practice Address - Phone:862-505-1713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty