Provider Demographics
NPI:1295882041
Name:COMPLETE PHYSICAL REHABILITATION PC
Entity type:Organization
Organization Name:COMPLETE PHYSICAL REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PUMARADA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-527-6001
Mailing Address - Street 1:701 NEWARK AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3560
Mailing Address - Country:US
Mailing Address - Phone:908-527-6001
Mailing Address - Fax:908-527-6634
Practice Address - Street 1:701 NEWARK AVE STE 212
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3560
Practice Address - Country:US
Practice Address - Phone:908-527-6001
Practice Address - Fax:908-527-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00071700171100000X
NJ225700000X
261QP2000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ082110Medicare ID - Type Unspecified