Organization
ACTIVE LIFE HEALTH OF NY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN J RUSH MD (CHAIRMAN & CHIEF EXECUTIVE OFFICER)
(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
PO BOX 772199, DETROIT, MI 48277-2223
(646) 586-9333
(646) 571-0807
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
03/07/2019
Last updated
12/04/2019
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