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General NPI Number Information
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NPI Number | 1801158720
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Entity Type | Organization
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Legal Business Name | MEDICINE AND REHABILITATION SERVICE PC
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 427 FORT WASHINGTON AVE APT 1A
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City | NEW YORK
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State | NY
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Zip | 10033-3522
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Country | US
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Telephone | 646-669-8192
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Fax | 646-669-8192
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Provider Business Mailing Address
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Address Line | 730 FORT WASHINGTON AVE APT 3N
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City | NEW YORK
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State | NY
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Zip | 10040-3738
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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 | MEDICAL DOCTOR
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Name | XIAOGUANG LIU
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Credential |
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Telephone | 718-530-5267
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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 | 233485
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License Number State | NY
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