Provider Demographics
NPI:1487869947
Name:TUCKER REHAB LLC
Entity type:Organization
Organization Name:TUCKER REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:201-391-8400
Mailing Address - Street 1:6 RAILROAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-2111
Mailing Address - Country:US
Mailing Address - Phone:201-391-8400
Mailing Address - Fax:201-391-9400
Practice Address - Street 1:6 RAILROAD AVENUE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-2111
Practice Address - Country:US
Practice Address - Phone:201-391-8400
Practice Address - Fax:201-391-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00876900261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
069448Medicare ID - Type Unspecified