1801158720 NPI number — MEDICINE AND REHABILITATION SERVICE PC

Table of content: (NPI 1801158720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801158720 NPI number — MEDICINE AND REHABILITATION SERVICE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICINE AND REHABILITATION SERVICE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801158720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 FORT WASHINGTON AVE
Provider Second Line Business Mailing Address:
APT 3N
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10040-3738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 FORT WASHINGTON AVE APT 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10033-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-669-8192
Provider Business Practice Location Address Fax Number:
646-669-8192
Provider Enumeration Date:
06/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LIU
Authorized Official First Name:
XIAOGUANG
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
718-530-5267

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  233485 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com