Provider Demographics
NPI:1265563738
Name:JERSEY REHAB PA
Entity type:Organization
Organization Name:JERSEY REHAB PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-482-1614
Mailing Address - Street 1:15 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1123
Mailing Address - Country:US
Mailing Address - Phone:973-482-1614
Mailing Address - Fax:973-485-6126
Practice Address - Street 1:3146 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5706
Practice Address - Country:US
Practice Address - Phone:718-792-6503
Practice Address - Fax:718-792-0096
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERSEY REHAB PA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA178991-22081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6540890001OtherDME NUMBER FOR NJ - PTAN
NJ1629005012OtherGROUP NPI NUMBER FOR MEDICARE NJ - NY AND NJ DME
NJ784955Medicare PIN
NJ1629005012OtherGROUP NPI NUMBER FOR MEDICARE NJ - NY AND NJ DME