Provider Demographics
NPI:1174869358
Name:INTEGRATIVE REHABILITATION MEDICINE PLLC
Entity type:Organization
Organization Name:INTEGRATIVE REHABILITATION MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-345-7079
Mailing Address - Street 1:680 KINDERKAMACK RD
Mailing Address - Street 2:SUITE #205
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1600
Mailing Address - Country:US
Mailing Address - Phone:201-345-7079
Mailing Address - Fax:845-547-0345
Practice Address - Street 1:680 KINDERKAMACK RD
Practice Address - Street 2:SUITE #205
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1600
Practice Address - Country:US
Practice Address - Phone:201-345-7079
Practice Address - Fax:845-547-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08800900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
213892Medicare PIN