Provider Demographics
NPI:1760965065
Name:IMGE REHABILITATION LLC
Entity Type:Organization
Organization Name:IMGE REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-637-9170
Mailing Address - Street 1:435 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3280
Mailing Address - Country:US
Mailing Address - Phone:917-355-7104
Mailing Address - Fax:
Practice Address - Street 1:2698 ROUTE 516 STE B
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2305
Practice Address - Country:US
Practice Address - Phone:917-355-7104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty