Provider Demographics
NPI:1679650790
Name:FOREST HILL REHABILITATION CENTER
Entity Type:Organization
Organization Name:FOREST HILL REHABILITATION CENTER
Other - Org Name:FOREST HILL PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:973-485-4766
Mailing Address - Street 1:465 MT PROSPECT AVE.
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104
Mailing Address - Country:US
Mailing Address - Phone:973-485-4766
Mailing Address - Fax:973-732-1141
Practice Address - Street 1:465 MT PROSPECT AVE.
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104
Practice Address - Country:US
Practice Address - Phone:973-485-4766
Practice Address - Fax:973-732-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00334600261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy