Provider Demographics
NPI:1750337564
Name:NORTH JERSEY REHAB LLC
Entity type:Organization
Organization Name:NORTH JERSEY REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:VOSOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-595-0063
Mailing Address - Street 1:PO BOX 43092
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-0092
Mailing Address - Country:US
Mailing Address - Phone:973-595-0063
Mailing Address - Fax:973-720-0408
Practice Address - Street 1:504 HAMBURG TPKE STE B105
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2034
Practice Address - Country:US
Practice Address - Phone:973-595-0063
Practice Address - Fax:973-240-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA70629174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8481008Medicaid
NJ8481008Medicaid
NJ046252Medicare ID - Type Unspecified
NJ6587920001Medicare NSC