Provider Demographics
NPI:1649374174
Name:NORTH JERSEY THERAPY CENTER LLC
Entity type:Organization
Organization Name:NORTH JERSEY THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GIACOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-595-7500
Mailing Address - Street 1:500 VALLEY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-595-7500
Mailing Address - Fax:973-595-7770
Practice Address - Street 1:500 VALLEY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-595-7500
Practice Address - Fax:973-595-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ314514Medicare ID - Type Unspecified