Provider Demographics
NPI:1548531015
Name:DONNELLY REHABILITATION SERVICES
Entity type:Organization
Organization Name:DONNELLY REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:609-529-7194
Mailing Address - Street 1:41 WATCHUNG PLZ
Mailing Address - Street 2:#346
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4117
Mailing Address - Country:US
Mailing Address - Phone:862-596-2989
Mailing Address - Fax:
Practice Address - Street 1:395 CLAREMONT AVE
Practice Address - Street 2:#2
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1879
Practice Address - Country:US
Practice Address - Phone:609-529-7194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00329400261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation