Basic Information
| Provider Information | |||||||||
| NPI: | 1427360676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED REHABILITATION SERVICES, LLC | ||||||||
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| OtherOrganizationName: | PEDIATRIC ADVANTAGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 NORTH AVE E | ||||||||
| Address2: | |||||||||
| City: | CRANFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070162491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082760237 | ||||||||
| FaxNumber: | 9082765692 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 NORTH AVE E | ||||||||
| Address2: | |||||||||
| City: | CRANFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070162491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082760237 | ||||||||
| FaxNumber: | 9082765692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2010 | ||||||||
| LastUpdateDate: | 07/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | OKAY | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTION | ||||||||
| AuthorizedOfficialTelephone: | 9082760237 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 225XP0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.