Basic Information
| Provider Information | |||||||||
| NPI: | 1427008911 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPLETE REHAB THERAPY P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 BORDENTOWN AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088791544 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 540 BORDENTOWN AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088791544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187437090 | ||||||||
| FaxNumber: | 7187437581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 12/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | FOOKSON | ||||||||
| AuthorizedOfficialFirstName: | IRINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7187437090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 46TR00142400 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.