Provider Demographics
NPI:1992825558
Name:WAYNE PHYSICAL MEDICINE & REHABILITATION ASSOCIATES
Entity Type:Organization
Organization Name:WAYNE PHYSICAL MEDICINE & REHABILITATION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIPPE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEMALY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-595-6066
Mailing Address - Street 1:401 HAMBURG TPKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2154
Mailing Address - Country:US
Mailing Address - Phone:973-595-6066
Mailing Address - Fax:973-595-1127
Practice Address - Street 1:401 HAMBURG TPKE
Practice Address - Street 2:SUITE 105
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2154
Practice Address - Country:US
Practice Address - Phone:973-595-6066
Practice Address - Fax:973-595-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7366701Medicaid
NJ068049Medicare PIN
NJG57115Medicare UPIN