Provider Demographics
NPI:1801012067
Name:EASTERN REHABILTATION NETWORK
Entity Type:Organization
Organization Name:EASTERN REHABILTATION NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICIER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-667-5480
Mailing Address - Street 1:1260 SILAS DEANE HIGHWAY
Mailing Address - Street 2:EASTERN REHABILTATION NETWORK
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109
Mailing Address - Country:US
Mailing Address - Phone:860-529-3179
Mailing Address - Fax:860-571-3282
Practice Address - Street 1:1260 SILAS DEANE HIGHWAY
Practice Address - Street 2:EASTERN REHABILTATION NETWORK
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109
Practice Address - Country:US
Practice Address - Phone:860-529-3179
Practice Address - Fax:860-571-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT225100000X, 225500000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076536Medicare ID - Type Unspecified