Basic Information
| Provider Information | |||||||||
| NPI: | 1801279054 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME REHABILITATION SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 JOHN WALSH BLVD STE 406A | ||||||||
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| City: | PEEKSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105665333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146319020 | ||||||||
| FaxNumber: | 9146319028 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MAIN ST STE 505 | ||||||||
| Address2: | |||||||||
| City: | EATONTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077243903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146319020 | ||||||||
| FaxNumber: | 9146319028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 12/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | LIEBERMANN | ||||||||
| AuthorizedOfficialFirstName: | YAFFA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9146319020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PT, GCS, | ||||||||
| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.