Provider Demographics
NPI:1629138102
Name:KEY PHYSMED PC
Entity Type:Organization
Organization Name:KEY PHYSMED PC
Other - Org Name:ALLIANCE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAHEEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABBASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-264-2714
Mailing Address - Street 1:250 MAPLE PL
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-1144
Mailing Address - Country:US
Mailing Address - Phone:732-264-2714
Mailing Address - Fax:732-264-9412
Practice Address - Street 1:250 MAPLE PL
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-1144
Practice Address - Country:US
Practice Address - Phone:732-264-2714
Practice Address - Fax:732-264-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037126Medicare PIN