| Bridgeway Rehabilitation Services | |
|
615 N Broad St Elizabeth NJ 07208-3409 | |
| (908) 355-7886 | |
| (908) 355-6668 |
| Full Name | Bridgeway Rehabilitation Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 615 N Broad St, Elizabeth, New Jersey |
| Authorized Official Name and Position | Cory Storch (DIRECTOR) |
| Authorized Official Contact | 9083557886 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeway Rehabilitation Services 615 N Broad St Elizabeth NJ 07208-3409 Ph: (908) 355-7886 | Bridgeway Rehabilitation Services 615 N Broad St Elizabeth NJ 07208-3409 Ph: (908) 355-7886 |
| NPI Number | 1639294879 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 01/11/2013 |
| Medicare PECOS PAC ID | 1658699715 |
|---|---|
| Medicare Enrollment ID | O20150421002263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639294879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 204011310 (New Jersey) | Primary |
| Provider Name | Joseph B Buceta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154392975 PECOS PAC ID: 7315834371 Enrollment ID: I20040303000791 |
| Provider Name | William J Annitto |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275660003 PECOS PAC ID: 7315130697 Enrollment ID: I20101019000866 |
| Provider Name | Yong-suk Zarski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982889291 PECOS PAC ID: 2062656549 Enrollment ID: I20130924000301 |
| Provider Name | Bohdan Czartorysky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457640609 PECOS PAC ID: 1456670447 Enrollment ID: I20150424000067 |
| Provider Name | Donna M Degiovine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558481002 PECOS PAC ID: 4880908375 Enrollment ID: I20150728004698 |
| Provider Name | Stephanie Simon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336210442 PECOS PAC ID: 2961716105 Enrollment ID: I20150803000199 |
| Provider Name | Thomas Crangle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134465370 PECOS PAC ID: 1254638539 Enrollment ID: I20160331001829 |
| Provider Name | Lissa Edmond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740642503 PECOS PAC ID: 9234429978 Enrollment ID: I20160608000971 |
| Provider Name | Tolulope Olajumoke Kolawole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598218042 PECOS PAC ID: 2365725488 Enrollment ID: I20170215000214 |
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