Provider Demographics
NPI:1790881563
Name:NORTHWEST REHABILITATION ASSOCIATES, PA
Entity Type:Organization
Organization Name:NORTHWEST REHABILITATION ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:VRABLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-989-5270
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-0313
Mailing Address - Country:US
Mailing Address - Phone:973-770-4842
Mailing Address - Fax:973-989-5274
Practice Address - Street 1:400 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885
Practice Address - Country:US
Practice Address - Phone:973-989-5270
Practice Address - Fax:973-989-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2877201Medicaid
NJ044369Medicare UPIN
NJ2877201Medicaid