Basic Information
| Provider Information | |||||||||
| NPI: | 1639105919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FALL PREVENTION AND REHABILITATION, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 MAIN ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | WEST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070525495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733242111 | ||||||||
| FaxNumber: | 7322120713 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 MAIN ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | WEST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070525495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733242111 | ||||||||
| FaxNumber: | 7322120713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | DUBNOFF | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9733242111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 363A00000X | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 225100000X | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 111N00000X | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 2742788000 | 01 | NJ | AMERIHEALTH | OTHER | DF2512 | 01 | NJ | RAILROAD MEDICARE | OTHER |