Provider Demographics
NPI:1962657874
Name:NEURO-REHABILITATION ASSOCIATES OF SOUTHERN NJ LLC
Entity Type:Organization
Organization Name:NEURO-REHABILITATION ASSOCIATES OF SOUTHERN NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROCKSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-896-2042
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-0356
Mailing Address - Country:US
Mailing Address - Phone:856-896-2042
Mailing Address - Fax:
Practice Address - Street 1:1237 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6920
Practice Address - Country:US
Practice Address - Phone:856-896-2042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA078168002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ140912Medicare PIN