Basic Information
| Provider Information | |||||||||
| NPI: | 1952708893 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OM REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 WINGED FOOT DR | ||||||||
| Address2: | |||||||||
| City: | MANALAPAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077269332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322167602 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21 WINGED FOOT DR | ||||||||
| Address2: | |||||||||
| City: | MANALAPAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077269332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322167602 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2014 | ||||||||
| LastUpdateDate: | 11/20/2014 | ||||||||
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| AuthorizedOfficialLastName: | POHUJA | ||||||||
| AuthorizedOfficialFirstName: | VARSHA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7322167602 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | 38MC00567900 | NJ | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 261QR0400X | 40QA01080900 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.