Provider Demographics
NPI:1457539595
Name:NEUROREHAB INSTITUTE LLC
Entity Type:Organization
Organization Name:NEUROREHAB INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:SOLEDAD
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-223-7079
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-0026
Mailing Address - Country:US
Mailing Address - Phone:973-601-0100
Mailing Address - Fax:973-398-2211
Practice Address - Street 1:111 HOWARD BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:MT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-1315
Practice Address - Country:US
Practice Address - Phone:973-601-0100
Practice Address - Fax:973-398-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00333800103G00000X
NJSI 03721103T00000X
NJ35S100448700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty