# ACTIVE LIFE MEDICAL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Arthritis Knee Pain Centers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417577479
- **Authorized official:** DR. JOHN J RUSH MD (CHAIRMAN & CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (301) 928-1697

## Contact information

- **Practice address:** 311 NORTH ST STE 406, WHITE PLAINS, NY 10605-2217
- **Practice address phone:** (914) 785-7752
- **Practice address fax:** (914) 363-0966
- **Mailing address:** 311 NORTH ST STE 406, WHITE PLAINS, NY 10605-2217
- **Mailing address phone:** (914) 785-7752
- **Mailing address fax:** (914) 363-0966

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/20/2020
- **Last updated:** 04/20/2020