Provider Demographics
NPI:1992848329
Name:NORTH JERSEY PROFESSIONAL REHABILITATION LLC
Entity Type:Organization
Organization Name:NORTH JERSEY PROFESSIONAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PT, OCS
Authorized Official - Phone:973-940-8910
Mailing Address - Street 1:122 NORTH CHURCH RD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3234
Mailing Address - Country:US
Mailing Address - Phone:973-940-8910
Mailing Address - Fax:973-940-8918
Practice Address - Street 1:122 NORTH CHURCH RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3234
Practice Address - Country:US
Practice Address - Phone:973-940-8910
Practice Address - Fax:973-940-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00640100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067945Medicare ID - Type Unspecified