Basic Information
| Provider Information | |||||||||
| NPI: | 1659709129 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPTIMA MEDICAL REHABILITATION P A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 ROUTE 35 | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | RED BANK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077015919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323834173 | ||||||||
| FaxNumber: | 7323836904 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 GREENWOOD AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MONTCLAIR | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070423649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737462424 | ||||||||
| FaxNumber: | 9737465030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2013 | ||||||||
| LastUpdateDate: | 05/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | NOVICK | ||||||||
| AuthorizedOfficialFirstName: | ELLEN | ||||||||
| AuthorizedOfficialMiddleName: | SOBERMAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9085911359 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 25MA05002200 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.