Organization
JERSEY REHAB PA
Active
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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