Provider Demographics
NPI:1356958037
Name:RECORA, INC
Entity type:Organization
Organization Name:RECORA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-688-3398
Mailing Address - Street 1:77 HUDSON ST APT 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2866
Mailing Address - Country:US
Mailing Address - Phone:347-688-3398
Mailing Address - Fax:
Practice Address - Street 1:77 HUDSON ST APT 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2866
Practice Address - Country:US
Practice Address - Phone:347-688-3398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679744833OtherNPI