Provider Demographics
NPI:1710368147
Name:UNIVERSAL REHABILITATION & FITNESS CENTER, INC
Entity Type:Organization
Organization Name:UNIVERSAL REHABILITATION & FITNESS CENTER, INC
Other - Org Name:UNIVERSAL INSTITUTE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCUDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-992-8181
Mailing Address - Street 1:15 MICROLAB RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1623
Mailing Address - Country:US
Mailing Address - Phone:973-992-8181
Mailing Address - Fax:973-992-7178
Practice Address - Street 1:1 COOPER AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-7404
Practice Address - Country:US
Practice Address - Phone:732-963-9446
Practice Address - Fax:732-272-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7340401Medicaid
NJ7340401Medicaid