# JERSEYREHAB

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** JERSEYREHAB
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1801927397
- **Legal business name:** JERSEYREHAB
- **Authorized official:** EDWIN M GANGEMI MD (MD)
- **Authorized official phone:** (973) 482-1614

## Contact information

- **Practice address:** 495 N 13TH ST, NEWARK, NJ 07107-1317
- **Practice address phone:** (973) 268-1444
- **Practice address fax:** (973) 482-3004
- **Mailing address:** 234 MOUNT PROSPECT AVE, NEWARK, NJ 07104-2006
- **Mailing address phone:** (973) 482-1614
- **Mailing address fax:** (973) 482-2715

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 25MA05600600 | NJ | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | 25MA06101800 | NJ | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 25MA06101800 | NJ | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | 25MA05600600 | NJ | — |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 05/16/2008