MEDICARE: MILLENNIUM MEDICAL AND REHABILITATION, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1265467963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM MEDICAL AND REHABILITATION, PC

Provider Business Mailing Address
First Line	:	1075 CENTRAL AVE
Second Line	:	STE 107
City	:	SCARSDALE
State	:	NY
Zip	:	10583
Country	:	US
Telephone Number	:	845-362-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 CENTRAL PARK AVE
Second Line	:	STE 107
City	:	SCARSDALE
State	:	NY
Zip	:	10583-3242
Country	:	US
Telephone Number	:	845-362-8400
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	TIN TIN WYNN
Credential	:	MD
Telephone Number	:	845-362-8400

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/22/2020

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