Healthcare Provider Details

I. General information

NPI: 1356958037
Provider Name (Legal Business Name): RECORA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HUDSON ST APT 5
NEW YORK NY
10013-2866
US

IV. Provider business mailing address

77 HUDSON ST APT 5
NEW YORK NY
10013-2866
US

V. Phone/Fax

Practice location:
  • Phone: 347-688-3398
  • Fax:
Mailing address:
  • Phone: 347-688-3398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name: EDWARD WU
Title or Position: COO
Credential: MD
Phone: 347-688-3398