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General NPI Number Information
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NPI Number | 1326692849
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE HEALTH OF MANHATTAN MEDICAL PLLC
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 57 W 57TH ST STE 611
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City | NEW YORK
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State | NY
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Zip | 10019-2802
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Country | US
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Telephone | 646-846-7444
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Fax | 646-571-0807
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Provider Business Mailing Address
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Address Line | PO BOX 772223
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City | DETROIT
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State | MI
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Zip | 48277-2223
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN J RUSH
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Credential | MD
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Telephone | 646-586-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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