Provider Demographics
NPI:1487852737
Name:ATLANTIC MEDICAL REHABILITATION LLC
Entity type:Organization
Organization Name:ATLANTIC MEDICAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-879-8202
Mailing Address - Street 1:8 CARLISLE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2058
Mailing Address - Country:US
Mailing Address - Phone:908-510-5081
Mailing Address - Fax:
Practice Address - Street 1:137 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2307
Practice Address - Country:US
Practice Address - Phone:908-852-1887
Practice Address - Fax:908-852-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05826300261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation