Organization
JERSEY REHAB PA
Active
Other names
Westchester Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN M GANGEMI MD (CREDENTIALING)
(973) 482-1614
Entity
Organization
Contact information
Practice address
77 NEWARK AVE, BELLEVILLE, NJ 07109-4143
(973) 844-9220
(973) 844-9221
Mailing address
234 MOUNT PROSPECT AVE, NEWARK, NJ 07104-2006
(973) 482-1614
(973) 485-6126
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
25MA05600600
NJ
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0037435
—
NJ
01
—
1184656373
DR MARINI NPI
NJ
01
—
1962433524
DR GANGEMI NPI
NJ
05
—
7198302
—
NJ
Enumeration date
03/08/2007
Last updated
11/01/2007
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