Provider Demographics
NPI:1710191051
Name:ADVANCED ASSOCIATES FOR DIAGNOSIS AND PHYSICAL REHABILITATION LLC
Entity Type:Organization
Organization Name:ADVANCED ASSOCIATES FOR DIAGNOSIS AND PHYSICAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-768-7211
Mailing Address - Street 1:277 CLOSTER DOCK RD
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2445
Mailing Address - Country:US
Mailing Address - Phone:201-768-7211
Mailing Address - Fax:201-768-2035
Practice Address - Street 1:277 CLOSTER DOCK RD
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2445
Practice Address - Country:US
Practice Address - Phone:201-768-7211
Practice Address - Fax:201-768-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03793261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID
NJ039190Medicare ID - Type UnspecifiedPROVIDER NUMBER