Healthcare Provider Details

I. General information

NPI: 1801158720
Provider Name (Legal Business Name): MEDICINE AND REHABILITATION SERVICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 FORT WASHINGTON AVE APT 1A
NEW YORK NY
10033-3522
US

IV. Provider business mailing address

730 FORT WASHINGTON AVE APT 3N
NEW YORK NY
10040-3738
US

V. Phone/Fax

Practice location:
  • Phone: 646-669-8192
  • Fax: 646-669-8192
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number233485
License Number StateNY

VIII. Authorized Official

Name: XIAOGUANG LIU
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 718-530-5267