Basic Information
| Provider Information | |||||||||
| NPI: | 1902018260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND REHABILITATION SERVICES OF NEW JERSEY, LLC | ||||||||
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| OtherOrganizationName: | HEARTLAND REHABILITATION SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 2ND ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | SWEDESBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080851138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562412222 | ||||||||
| FaxNumber: | 8562417961 | ||||||||
| Practice Location | |||||||||
| Address1: | 389 HARDING HWY | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | PITTSGROVE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083182057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563584500 | ||||||||
| FaxNumber: | 8563584502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 04/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | LAZARUS | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT-REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4192525541 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.