Provider Demographics
NPI:1558454702
Name:NEW JERSEY REHAB AND ELECTRODIAGNOSTICS PA
Entity type:Organization
Organization Name:NEW JERSEY REHAB AND ELECTRODIAGNOSTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANJU
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-429-7799
Mailing Address - Street 1:100 DAVIDSON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1312
Mailing Address - Country:US
Mailing Address - Phone:908-429-7799
Mailing Address - Fax:866-611-9616
Practice Address - Street 1:10 STERLING DR
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4911
Practice Address - Country:US
Practice Address - Phone:908-429-7799
Practice Address - Fax:866-611-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ055890Medicare PIN