Organization
PEDIATRIC REHABILITATION OF NORTH JERSEY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARISSA M MUCCIO PT (PRESIDENT)
(973) 628-1300
Entity
Organization
Contact information
Practice address
309 BLACK OAK RIDGE RD, WAYNE, NJ 07470-6504
(973) 628-1300
(973) 628-0300
Mailing address
309 BLACK OAK RIDGE RD, WAYNE, NJ 07470-6504
(973) 628-1300
(973) 628-0300
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
40QA00794200
NJ
Other
Enumeration date
01/17/2007
Last updated
03/18/2014
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