Provider Demographics
NPI:1679866404
Name:ELITE REHABILITATION CENTER OF PASSAIC LLC
Entity Type:Organization
Organization Name:ELITE REHABILITATION CENTER OF PASSAIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-773-9190
Mailing Address - Street 1:615 MAIN AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4920
Mailing Address - Country:US
Mailing Address - Phone:973-773-9190
Mailing Address - Fax:973-773-9191
Practice Address - Street 1:615 MAIN AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4920
Practice Address - Country:US
Practice Address - Phone:973-773-9190
Practice Address - Fax:973-773-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty