Basic Information
| Provider Information | |||||||||
| NPI: | 1790210177 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEM REHAB PT, OT, SLP, PLLC | ||||||||
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| OtherOrganizationName: | GEM REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 VETERANS DR | ||||||||
| Address2: | |||||||||
| City: | NORTHVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076472308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452414800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 W SHEEDY RD | ||||||||
| Address2: | |||||||||
| City: | VESTAL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138503334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077544105 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2017 | ||||||||
| LastUpdateDate: | 04/24/2017 | ||||||||
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| AuthorizedOfficialLastName: | GIOFFRE | ||||||||
| AuthorizedOfficialFirstName: | DARREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8452414800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.