Provider Demographics
NPI:1700043841
Name:NORTH JERSEY REHABILITATION CENTER PC
Entity Type:Organization
Organization Name:NORTH JERSEY REHABILITATION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYUNG
Authorized Official - Middle Name:P
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-944-5999
Mailing Address - Street 1:120 VAN NOSTRAND AVE 1ST FL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:201-944-5999
Mailing Address - Fax:201-947-3994
Practice Address - Street 1:120 VAN NOSTRAND AVE 1ST FL
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632
Practice Address - Country:US
Practice Address - Phone:201-944-5999
Practice Address - Fax:201-947-3994
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH JERSEY REHABILITATION CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05070111N00000X
171100000X
NJ4DQA01076000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty