Provider Demographics
NPI:1255446407
Name:PRIMARY CARE & REHABILITATION PC
Entity type:Organization
Organization Name:PRIMARY CARE & REHABILITATION PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRGENTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-779-7774
Mailing Address - Street 1:1030 N KINGS HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1907
Mailing Address - Country:US
Mailing Address - Phone:856-779-7773
Mailing Address - Fax:
Practice Address - Street 1:1030 KINGS HWY N
Practice Address - Street 2:SUITE 200
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1907
Practice Address - Country:US
Practice Address - Phone:856-779-7773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06045900208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ574255MJQMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER