Provider Demographics
NPI:1861789505
Name:NORTHEAST REHABILITATION INC.
Entity type:Organization
Organization Name:NORTHEAST REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:V
Authorized Official - Last Name:TAWALARE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, CHT
Authorized Official - Phone:845-623-6566
Mailing Address - Street 1:281 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1017
Mailing Address - Country:US
Mailing Address - Phone:845-623-6566
Mailing Address - Fax:845-623-6556
Practice Address - Street 1:275 N MIDDLETOWN RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1188
Practice Address - Country:US
Practice Address - Phone:845-623-6566
Practice Address - Fax:845-623-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012255-12251H1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty