Provider Demographics
NPI:1255640496
Name:NORTH JERSEY PRO REHAB
Entity type:Organization
Organization Name:NORTH JERSEY PRO REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-940-8910
Mailing Address - Street 1:122 NORTH CHURCH RD.
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-0000
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:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-0000
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:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00088500261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy