NPIMap

Organization Active NPI

Pediatric Rehabilitation of North Jersey PC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Wayne, NJ
National Provider Identifier
1396897773
Registry record updated Mar 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
License
40QA00794200 Issued in NJ
Legal business name
PEDIATRIC REHABILITATION OF NORTH JERSEY PC
Practice address
309 Black Oak Ridge Rd
Wayne, NJ 07470-6504
Phone
(973) 628-1300
Fax
(973) 628-0300
NPI assigned
Jan 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Marissa M Muccio, PTNPI 1396872297
Title
President
Phone
(973) 628-1300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X 40QA00794200 NJ Primary

Addresses

Primary practice location

309 Black Oak Ridge Rd
Wayne, NJ 07470-6504

Mailing address

309 Black Oak Ridge Rd
Wayne, NJ 07470-6504
Phone (973) 628-1300

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395100800000",
    "number": "1396897773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 BLACK OAK RIDGE RD",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074706504",
            "telephone_number": "973-628-1300",
            "fax_number": "973-628-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 BLACK OAK RIDGE RD",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074706504",
            "telephone_number": "973-628-1300",
            "fax_number": "973-628-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC REHABILITATION OF NORTH JERSEY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2014-03-18",
        "status": "A",
        "authorized_official_last_name": "MUCCIO",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-628-1300",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "NJ",
            "license": "40QA00794200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.