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Organization
PEDIATRIC REHABILITATION ASSOCIATES, LLC
Active
Organization
PEDIATRIC REHABILITATION ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE DOMINGO MD (PRESIDENT)
(609) 410-8055
Entity
Organization
Contact information
Practice address
92 BRICK RD FL 3, MARLTON, NJ 08053-2177
(856) 489-4520
Mailing address
PO BOX 674, MARLTON, NJ 08053-0674
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
25MA06376400
NJ
Other
Enumeration date
10/04/2016
Last updated
02/27/2017
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