MEDICARE: SUNRISE MEDICAL CARE, 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	208100000X	Physical Medicine & Rehabilitation Physician	235794	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902057508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE MEDICAL CARE, PC

Provider Business Mailing Address
First Line	:	762 59TH ST APT 6
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3920
Country	:	US
Telephone Number	:	718-439-8700
Fax Number	:	718-439-8702

Provider Business Practice Location Address
First Line	:	762 59TH ST APT 6
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3920
Country	:	US
Telephone Number	:	718-439-8700
Fax Number	:	718-439-8702

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LISA S REN
Credential	:	M.D.
Telephone Number	:	718-439-8700

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	10/01/2008

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