Provider Demographics
NPI:1255372108
Name:NEW ERA REHABILITATION CENTER, INC
Entity type:Organization
Organization Name:NEW ERA REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:ADEKUNLE
Authorized Official - Last Name:KOLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-562-2101
Mailing Address - Street 1:4675 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2864
Mailing Address - Country:US
Mailing Address - Phone:203-344-0025
Mailing Address - Fax:203-374-7515
Practice Address - Street 1:4675 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2864
Practice Address - Country:US
Practice Address - Phone:203-344-0025
Practice Address - Fax:203-374-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0266261QR0401X, 261QR0405X, 261QM2800X
CT042947204D00000X, 207QA0401X
CT040029207RA0401X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4224507Medicaid
CT4224507Medicaid
CTF41823Medicare UPIN
CT080001764Medicare ID - Type UnspecifiedNUMBER FOR DR C.KOLADE
CT110009650Medicare ID - Type UnspecifiedNUMBER FOR DR E. KOLADE
CTC03408Medicare PIN