# ACTIVE LIFE HEALTH OF GARDEN CITY MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902451107
- **Authorized official:** DR. JOHN J RUSH (OWNER)
- **Authorized official phone:** (301) 928-1697

## Contact information

- **Practice address:** 623 STEWART AVE, GARDEN CITY, NY 11530-4771
- **Practice address phone:** (516) 331-2082
- **Practice address fax:** (516) 784-5232
- **Mailing address:** 623 STEWART AVE, GARDEN CITY, NY 11530-4771
- **Mailing address phone:** (516) 331-2082
- **Mailing address fax:** (516) 784-5232

## Taxonomy

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

## Other

- **Enumeration date:** 08/05/2019
- **Last updated:** 08/07/2019