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General NPI Number Information
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NPI Number | 1902451107
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE HEALTH OF GARDEN CITY MEDICAL PLLC
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 623 STEWART AVE
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City | GARDEN CITY
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State | NY
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Zip | 11530-4771
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Country | US
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Telephone | 516-331-2082
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Fax | 516-784-5232
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Provider Business Mailing Address
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Address Line | 623 STEWART AVE
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City | GARDEN CITY
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State | NY
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Zip | 11530-4771
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Country | US
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Telephone | 516-331-2082
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Fax | 516-784-5232
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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 |
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Telephone | 301-928-1697
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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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