Provider Demographics
NPI:1790880524
Name:ADVANCED REHABILITATION, LLC
Entity Type:Organization
Organization Name:ADVANCED REHABILITATION, LLC
Other - Org Name:ADVANCED REHABILITATION OF JERSEY CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-624-2111
Mailing Address - Street 1:550 NEWARK AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-624-2111
Mailing Address - Fax:
Practice Address - Street 1:550 NEWARK AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-624-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00649400111N00000X
NJ38MC00648900111N00000X
NJ40QA01040800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6135400001Medicare NSC