Provider Demographics
NPI:1861526550
Name:SHEA REHABILITATION SERVICES INC.
Entity type:Organization
Organization Name:SHEA REHABILITATION SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-396-1332
Mailing Address - Street 1:100 E PASSAIC AVE APT C6
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3015
Mailing Address - Country:US
Mailing Address - Phone:201-396-1332
Mailing Address - Fax:973-437-4579
Practice Address - Street 1:450 BERGEN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2291
Practice Address - Country:US
Practice Address - Phone:201-396-1332
Practice Address - Fax:973-437-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00198200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ210271Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER