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General NPI Number Information
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NPI Number | 1265467963
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Entity Type | Organization
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Legal Business Name | MILLENNIUM MEDICAL AND REHABILITATION, PC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1075 CENTRAL PARK AVE STE 107
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City | SCARSDALE
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State | NY
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Zip | 10583-3242
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Country | US
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Telephone | 845-362-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 1075 CENTRAL AVE STE 107
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City | SCARSDALE
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State | NY
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Zip | 10583
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Country | US
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Telephone | 845-362-8400
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | TIN TIN WYNN
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Credential | MD
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Telephone | 845-362-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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