Provider Demographics
NPI:1881667277
Name:BEACHWOOD LOW BACK REHAB CENTER
Entity Type:Organization
Organization Name:BEACHWOOD LOW BACK REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-244-8666
Mailing Address - Street 1:137 ATLANTIC CITY BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722-2935
Mailing Address - Country:US
Mailing Address - Phone:732-244-8666
Mailing Address - Fax:732-244-0450
Practice Address - Street 1:137 ATLANTIC CITY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:BEACHWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08722-2935
Practice Address - Country:US
Practice Address - Phone:732-244-8666
Practice Address - Fax:732-244-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2009-04-16
Deactivation Date:2009-04-14
Deactivation Code:
Reactivation Date:2009-04-16
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03808800208D00000X
NJ40QA00497000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066749Medicare ID - Type Unspecified