Provider Demographics
NPI:1902265978
Name:VIRTUA-IVY REHAB LLC
Entity Type:Organization
Organization Name:VIRTUA-IVY REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/EVP
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-355-0012
Mailing Address - Street 1:303 LIPPINCOTT DR
Mailing Address - Street 2:2ND FLOOR - ATTN: FRAN BLACKWELL
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4160
Mailing Address - Country:US
Mailing Address - Phone:856-355-0032
Mailing Address - Fax:
Practice Address - Street 1:773 E ROUTE 70
Practice Address - Street 2:BLDG E-110
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2362
Practice Address - Country:US
Practice Address - Phone:856-282-0339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRTUA HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy