Red Bank Neurorehabilitation Associates, LLC
Organization Active NPI Clinical Neuropsychologist · Red Bank, NJ
NPI 1780930834 · NPPES record last updated Nov 7, 2012
Key facts
- NPI
- 1780930834
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Neuropsychologist 103G00000X
- Legal business name
- RED BANK NEUROREHABILITATION ASSOCIATES, LLC
- Practice address
- 12 Reckless PL
Red Bank, NJ 07701-1704 - Phone
- (908) 692-9485
- NPI assigned
- Jul 26, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Joseph Marcantuono, PH.D.
- Title
- Clinical Psychologist/Partner
- Phone
- (908) 692-9485
Practitioners 3
-
Michael Joseph Ellis, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121112000089 | NJ | Part B Supplier - Clinic/Group Practice | 6800047259 |
Receives reassigned benefits from 1 practitioner Practice locations: Red Bank, NJ |
National Provider Directory
Locations
700 Godwin Ave
Ste 100
Midland Park, NJ 07432
55 State Route 35
Ste 5
Red Bank, NJ 07701
Phone (609) 619-0647
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist |
103G00000X | Yes | ||
| Counseling Psychologist |
103TC1900X | |||
| Rehabilitation Psychologist |
103TR0400X |
Addresses
Primary practice location
12 Reckless PL
Red Bank, NJ 07701-1704
Mailing address
12 Reckless PL
Red Bank, NJ 07701-1704
Phone (908) 692-9485
Other providers in Red Bank, NJ
- Red Bank Counseling LLC
- Red Bank Dental Associates
- Red Bank Family Chiropractic Clinic PA
- Red Bank Family Pharmacy Inc
- Red Bank Gastroenterology Associates, PA
- Red Bank Pharmacy
- Red Bank Public School District
- Larissa Redziniak
- Amy Boltz Regina
- Kyle Reinhardt
All providers in Red Bank, NJ · Clinical Neuropsychologist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.