Provider Demographics
NPI:1548894983
Name:ACTIVE LIFE HEALTH OF MANHATTAN MEDICAL PLLC
Entity type:Organization
Organization Name:ACTIVE LIFE HEALTH OF MANHATTAN MEDICAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-586-9333
Mailing Address - Street 1:57 W 57TH ST STE 1603
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2833
Mailing Address - Country:US
Mailing Address - Phone:646-586-9333
Mailing Address - Fax:646-571-0807
Practice Address - Street 1:57 W 57TH ST STE 611
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:646-586-9333
Practice Address - Fax:646-571-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies