Provider Demographics
NPI:1689675472
Name:REHABILITATION MEDICINE & ACUPUNCTURE CENTER MD LLC
Entity Type:Organization
Organization Name:REHABILITATION MEDICINE & ACUPUNCTURE CENTER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUN
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-637-7720
Mailing Address - Street 1:1171 E PUTNAM AVE
Mailing Address - Street 2:BLDG 1 2ND FLOOR
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1426
Mailing Address - Country:US
Mailing Address - Phone:203-637-7720
Mailing Address - Fax:203-637-2693
Practice Address - Street 1:1171 E PUTNAM AVE
Practice Address - Street 2:BLDG 1 2ND FLOOR
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1426
Practice Address - Country:US
Practice Address - Phone:203-637-7720
Practice Address - Fax:203-637-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000638171100000X
CT038206208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12103Medicare UPIN