Organization
JERSEY REHAB PA
Active
Other names
Jersey Rehab PA PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN M. GANGEMI M.D. (MD)
(973) 482-1614
Entity
Organization
Contact information
Practice address
15 NEWARK AVE, BELLEVILLE, NJ 07109-1123
(973) 844-9220
(973) 844-9221
Mailing address
15 NEWARK AVE, BELLEVILLE, NJ 07109-1123
(973) 482-1614
(973) 485-6126
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A100001253
MEDICARE PTAN NEW FOR NY
NY
Enumeration date
06/28/2006
Last updated
10/23/2012
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