Provider Demographics
NPI:1326123753
Name:WESTCHESTER MEDICAL REHABILITATION & ACUPUNCTURE PC
Entity Type:Organization
Organization Name:WESTCHESTER MEDICAL REHABILITATION & ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SU
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD; PHD
Authorized Official - Phone:914-815-2935
Mailing Address - Street 1:330 CENTRAL PARK AVE APT F3
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1355
Mailing Address - Country:US
Mailing Address - Phone:914-815-2935
Mailing Address - Fax:914-347-5003
Practice Address - Street 1:116 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1910
Practice Address - Country:US
Practice Address - Phone:914-815-2935
Practice Address - Fax:914-347-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2154432081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH22513Medicare UPIN
NY71Z301Medicare ID - Type Unspecified