Provider Demographics
NPI:1912037482
Name:BOSTON ASSOCIATES REHABILITATION LLC
Entity Type:Organization
Organization Name:BOSTON ASSOCIATES REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SUPERNAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:856-299-9229
Mailing Address - Street 1:291 HARDING HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARNEYS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08069-2229
Mailing Address - Country:US
Mailing Address - Phone:856-299-9229
Mailing Address - Fax:856-299-9226
Practice Address - Street 1:291 HARDING HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:CARNEYS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08069-2229
Practice Address - Country:US
Practice Address - Phone:856-299-9229
Practice Address - Fax:856-299-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01075700261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation