Provider Demographics
NPI:1477610822
Name:PERSONAL BEST REHAB PT PC
Entity type:Organization
Organization Name:PERSONAL BEST REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SIMINIG
Authorized Official - Last Name:SAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:201-447-1112
Mailing Address - Street 1:611 N MAPLE AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1668
Mailing Address - Country:US
Mailing Address - Phone:201-447-1112
Mailing Address - Fax:201-447-1180
Practice Address - Street 1:611 N MAPLE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1668
Practice Address - Country:US
Practice Address - Phone:201-447-1112
Practice Address - Fax:201-447-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00766700261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ117886Medicare PIN