Basic Information
| Provider Information | |||||||||
| NPI: | 1851496004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL REHABILITATION CONSULTANTS,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3111 ROUTE 38 | ||||||||
| Address2: | BLDG 11 PMB 104 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080549754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092615755 | ||||||||
| FaxNumber: | 6092617199 | ||||||||
| Practice Location | |||||||||
| Address1: | 3111 ROUTE 38 | ||||||||
| Address2: | BLDG 11 PMB 104 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080549754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092615755 | ||||||||
| FaxNumber: | 6092617199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BASTIEN | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6092615755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.