Provider Demographics
NPI:1851455562
Name:ADVANCED PERFORMANCE AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED PERFORMANCE AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-467-9011
Mailing Address - Street 1:532 OLD SHORT HILLS RD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1437
Mailing Address - Country:US
Mailing Address - Phone:973-467-9011
Mailing Address - Fax:973-467-9012
Practice Address - Street 1:532 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-1437
Practice Address - Country:US
Practice Address - Phone:973-467-9011
Practice Address - Fax:973-467-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC4865111N00000X
NJ25MD00276900213ES0103X
NJ40QA01072600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV00319Medicare UPIN
NJX87568Medicare UPIN
NJ078601RLCMedicare ID - Type UnspecifiedLOVELYN RAVAGO
NJ844121RLCMedicare ID - Type UnspecifiedJASON LEVY
NJ080585RLCMedicare ID - Type UnspecifiedJESSICA MERKER-LEVY