Provider Demographics
NPI:1770352791
Name:ABBY MEDICAL CENTER CARDIAC REHABILITATION LLC
Entity type:Organization
Organization Name:ABBY MEDICAL CENTER CARDIAC REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MANJERICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-540-6051
Mailing Address - Street 1:1 CENTURIAN DR STE 303
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 CENTURIAN DR STE 303
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2127
Practice Address - Country:US
Practice Address - Phone:302-229-9857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C1106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiac-Interventional TechnologyGroup - Single Specialty