Provider Demographics
NPI:1306896311
Name:RHODE ISLAND REHABILITATION INSTITUTE P.C,
Entity type:Organization
Organization Name:RHODE ISLAND REHABILITATION INSTITUTE P.C,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SISUN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:401-946-4250
Mailing Address - Street 1:721 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4430
Mailing Address - Country:US
Mailing Address - Phone:401-946-4250
Mailing Address - Fax:401-942-3960
Practice Address - Street 1:721 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4430
Practice Address - Country:US
Practice Address - Phone:401-946-4250
Practice Address - Fax:401-942-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235110073OtherOWNER /OP NATIONAL PIN #
RIHPAA46233OtherHARVARD PILGRIM HC GROUP
RICA-6711OtherRAILROAD MEDICARE GROUP
RI7536-1OtherBCBSRI GROUP #
RI19016OtherNEIGHBORHOOD HEALTH PLAN
RI484225OtherAETNA
RI64-00132OtherUHC
RI659007536Medicare PIN
RICA-6711OtherRAILROAD MEDICARE GROUP
RI484225OtherAETNA
MACA6711Medicare PIN