Center for Primary Care and Rehabilitation, PA

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

License

45600 Issued in MN

Legal business name

CENTER FOR PRIMARY CARE AND REHABILITATION, PA

Practice address

880 Blue Gentian Rd Ste 165
Eagan, MN 55121-1772

Phone

(651) 789-8022

Fax

(651) 789-8028

NPI assigned

Aug 12, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elena Lev Polukhin, MD, PHD

Title

Owner/Medical Director

Phone

(651) 789-8022

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313107200000",
    "number": "1780963355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3006 FRANK ST",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095501",
            "telephone_number": "651-789-8022",
            "fax_number": "651-789-8028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 BLUE GENTIAN RD STE 165",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211772",
            "telephone_number": "651-789-8022",
            "fax_number": "651-789-8028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR PRIMARY CARE AND REHABILITATION, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-12",
        "last_updated": "2011-08-12",
        "status": "A",
        "authorized_official_last_name": "POLUKHIN",
        "authorized_official_first_name": "ELENA",
        "authorized_official_middle_name": "LEV",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "651-789-8022",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Rehabilitation Practitioner",
            "state": "MN",
            "license": "45600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rehabilitation Practitioner in Eagan, MN
• Providers in Eagan, MN by specialty
• Rehabilitation Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.