Provider Demographics
NPI:1912356288
Name:MEDICAL REHABILITATION CARE, PC
Entity Type:Organization
Organization Name:MEDICAL REHABILITATION CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSHNI
Authorized Official - Middle Name:
Authorized Official - Last Name:DURGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-729-5808
Mailing Address - Street 1:80 IVY ST
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 IVY ST
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3406
Practice Address - Country:US
Practice Address - Phone:516-729-5808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09862400314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility