Provider Demographics
NPI:1881817476
Name:HEALTH ONE MEDICAL & PHYSICAL REHABILITATION LLC
Entity Type:Organization
Organization Name:HEALTH ONE MEDICAL & PHYSICAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARAHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-791-0707
Mailing Address - Street 1:1 BROADWAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1842
Mailing Address - Country:US
Mailing Address - Phone:201-791-0707
Mailing Address - Fax:201-791-0048
Practice Address - Street 1:1 BROADWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1842
Practice Address - Country:US
Practice Address - Phone:201-791-0707
Practice Address - Fax:201-791-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6050000001Medicare NSC