Healthcare Provider Details

I. General information

NPI: 1689675472
Provider Name (Legal Business Name): REHABILITATION MEDICINE & ACUPUNCTURE CENTER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 E PUTNAM AVE BLDG 1 2ND FLOOR
RIVERSIDE CT
06878-1426
US

IV. Provider business mailing address

1171 E PUTNAM AVE BLDG 1 2ND FLOOR
RIVERSIDE CT
06878-1426
US

V. Phone/Fax

Practice location:
  • Phone: 203-637-7720
  • Fax: 203-637-2693
Mailing address:
  • Phone: 203-637-7720
  • Fax: 203-637-2693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000638
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number038206
License Number StateCT

VIII. Authorized Official

Name: JUN XU
Title or Position: PRESIDENT
Credential: MD
Phone: 203-637-7720