# JEFFERSON REHABILITATION CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043519986
- **Authorized official:** HOWARD GANTER (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (315) 788-2730

## Contact information

- **Practice address:** 420 GAFFNEY DR, WATERTOWN, NY 13601-1823
- **Practice address phone:** (315) 788-2730
- **Practice address fax:** (315) 788-8557
- **Mailing address:** 420 GAFFNEY DR, WATERTOWN, NY 13601-1823

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 016569-1 | NY | Yes |

## Other

- **Enumeration date:** 03/17/2011
- **Last updated:** 03/17/2011