Provider Demographics
NPI:1780113100
Name:FUSION REHABILITATIVE MEDICINE, LLC
Entity type:Organization
Organization Name:FUSION REHABILITATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-631-4410
Mailing Address - Street 1:3 HOSPITAL PLZ STE 203
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3084
Mailing Address - Country:US
Mailing Address - Phone:732-631-4410
Mailing Address - Fax:844-350-5451
Practice Address - Street 1:3 HOSPITAL PLAZA
Practice Address - Street 2:SUITE 203
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:732-631-4410
Practice Address - Fax:844-350-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08584900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty