Organization
ACTIVE LIFE HEALTH OF NY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN J RUSH MD (OWNER)
(301) 928-1697
Entity
Organization
Contact information
Practice address
300 E MAIN ST STE 1, SMITHTOWN, NY 11787-2900
(631) 656-8796
(631) 333-7322
Mailing address
363 ROUTE 111, STE 107-B, SMITHTOWN, NY 11787-4756
(631) 656-5544
(631) 656-5545
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
2611911
TX
Other
Enumeration date
09/06/2011
Last updated
03/04/2019
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