Provider Demographics
NPI:1760965065
Name:IMGE REHABILITATION LLC
Entity type:Organization
Organization Name:IMGE REHABILITATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-355-7104
Mailing Address - Street 1:435 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3280
Mailing Address - Country:US
Mailing Address - Phone:917-355-7104
Mailing Address - Fax:
Practice Address - Street 1:200 MIDDLESEX ESSEX TPKE STE 304
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2033
Practice Address - Country:US
Practice Address - Phone:732-455-2343
Practice Address - Fax:732-860-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty