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General NPI Number Information
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NPI Number | 1205263290
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Entity Type | Organization
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Legal Business Name | SUNRISE PAIN AND REHABILITATION MEDICINE PC
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 4602 6TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11220-1317
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Country | US
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Telephone | 347-763-1091
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Fax | 347-763-1092
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Provider Business Mailing Address
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Address Line | 4602 6TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11220-1317
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Country | US
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Telephone | 347-763-1091
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Fax | 347-763-1092
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. WANDA WANG
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Credential |
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Telephone | 347-763-1091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 2030351
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License Number State | NY
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