Organization
NEW ERA REHABILITATION CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EBENEZER ADEKUNLE KOLADE MD (EXECUTIVE DIRECTOR)
(203) 562-2101
Entity
Organization
Contact information
Practice address
4675 MAIN STREET, BRIDGEPORT, CT 06606-2864
(203) 344-0025
(203) 374-7515
Mailing address
4675 MAIN STREET, BRIDGEPORT, CT 06606-2864
(203) 344-0025
(203) 374-7515
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
042947
CT
207QA0401X
Addiction Medicine (Family Medicine) Physician
042947
CT
207RA0401X
Addiction Medicine (Internal Medicine) Physician
040029
CT
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM2800X
Methadone Clinic
Primary
0266
CT
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
0266
CT
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
0266
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4224507
—
CT
Enumeration date
06/10/2006
Last updated
05/12/2021
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