Provider Demographics
NPI:1659729697
Name:PROGRESSIVE REHAB PA
Entity Type:Organization
Organization Name:PROGRESSIVE REHAB PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJU
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTAGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-906-2223
Mailing Address - Street 1:16 CARROLL DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4072
Mailing Address - Country:US
Mailing Address - Phone:908-906-2223
Mailing Address - Fax:
Practice Address - Street 1:16 CARROLL DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4072
Practice Address - Country:US
Practice Address - Phone:908-906-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06830200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty