Provider Demographics
NPI:1851496004
Name:MEDICAL REHABILITATION CONSULTANTS,LLC
Entity Type:Organization
Organization Name:MEDICAL REHABILITATION CONSULTANTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-261-5755
Mailing Address - Street 1:3111 ROUTE 38
Mailing Address - Street 2:BLDG 11 PMB 104
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9754
Mailing Address - Country:US
Mailing Address - Phone:609-261-5755
Mailing Address - Fax:609-261-7199
Practice Address - Street 1:3111 ROUTE 38
Practice Address - Street 2:BLDG 11 PMB 104
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9754
Practice Address - Country:US
Practice Address - Phone:609-261-5755
Practice Address - Fax:609-261-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086515Medicare ID - Type Unspecified