NPIMap

Organization Active NPI

Jersey Rehab PA

  • Physical Medicine & Rehabilitation Physician
  • Belleville, NJ
National Provider Identifier
1629005012
Registry record updated Oct 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
JERSEY REHAB PA
Practice address
15 Newark Ave
Belleville, NJ 07109-1123
Phone
(973) 844-9220
Fax
(973) 844-9221
NPI assigned
Jun 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2012

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

Authorized official

Name
Dr. Edwin M. Gangemi, M.D.
Title
MD
Phone
(973) 482-1614

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X

Addresses

Primary practice location

15 Newark Ave
Belleville, NJ 07109-1123

Mailing address

15 Newark Ave
Belleville, NJ 07109-1123
Phone (973) 482-1614

Other identifiers 1

IdentifierTypeStateIssuer
A100001253OtherNYMEDICARE PTAN NEW FOR NY

Other names 1

  • Jersey Rehab PA PC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040830000390 NJ Part B Supplier - Clinic/Group Practice 4082689468 Receives reassigned benefits from 6 practitioners
Practice locations: Belleville, NJ
O20090508000547 NY Part B Supplier - Clinic/Group Practice 4082689468 Receives reassigned benefits from 2 practitioners
Practice locations: Bronx, NY

National Provider Directory

National Provider Directory

Locations

15 Newark Ave
Belleville, NJ 07109
Phone (973) 482-1614

Practitioners & affiliated clinicians

Practitioners 6

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": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1629005012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 NEWARK AVE",
            "city": "BELLEVILLE",
            "state": "NJ",
            "postal_code": "071091123",
            "telephone_number": "973-482-1614",
            "fax_number": "973-485-6126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 NEWARK AVE",
            "city": "BELLEVILLE",
            "state": "NJ",
            "postal_code": "071091123",
            "telephone_number": "973-844-9220",
            "fax_number": "973-844-9221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERSEY REHAB PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "GANGEMI",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "973-482-1614",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN NEW FOR NY",
            "identifier": "A100001253",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jersey Rehab PA PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Belleville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.