Provider Demographics
NPI:1437194628
Name:HUNTINGTON REHABILITATION MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:HUNTINGTON REHABILITATION MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:HEGDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-403-1444
Mailing Address - Street 1:630 S. RAYMOND AVE
Mailing Address - Street 2:STE #120
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3036
Mailing Address - Country:US
Mailing Address - Phone:626-403-1444
Mailing Address - Fax:626-403-1448
Practice Address - Street 1:630 S. RAYMOND AVE
Practice Address - Street 2:STE #120
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3036
Practice Address - Country:US
Practice Address - Phone:626-403-1444
Practice Address - Fax:626-403-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0063130Medicaid
CAGR0063130Medicaid