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NPI Code Detail

MEDICARE: REHABILITATION MEDICINE & ACUPUNCTURE CENTER MD LLC

MEDICARE: REHABILITATION MEDICINE & ACUPUNCTURE CENTER MD LLC
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
1171100000XAcupuncturist000638NY
2208100000XPhysical Medicine & Rehabilitation Physician038206CT

General Provider Information

NPI Number : 1689675472
Entity Type Code : Organization
Provider Name (Legal Business Name) : REHABILITATION MEDICINE & ACUPUNCTURE CENTER MD LLC
Provider Business Mailing Address
First Line : 1171 E PUTNAM AVE
Second Line : BLDG 1 2ND FLOOR
City : RIVERSIDE
State : CT
Zip : 06878-1426
Country : US
Telephone Number : 203-637-7720
Fax Number : 203-637-2693
Provider Business Practice Location Address
First Line : 1171 E PUTNAM AVE
Second Line : BLDG 1 2ND FLOOR
City : RIVERSIDE
State : CT
Zip : 06878-1426
Country : US
Telephone Number : 203-637-7720
Fax Number : 203-637-2693
Authorized Official
Title or Position : PRESIDENT
Name : JUN XU
Credential : MD
Telephone Number : 203-637-7720
Provider Enumeration Date : 08/03/2005
Last Update Date : 08/27/2007

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