MEDICARE: METRO ATHLETIC MEDICINE&FITNESS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist
3	332BD1200X	Dialysis Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1134372766	OTHER	NY	DME

General Provider Information

NPI Number	:	1134372766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO ATHLETIC MEDICINE&FITNESS PC

Provider Business Mailing Address
First Line	:	263 7TH AVE
Second Line	:	SUITE 2A
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3689
Country	:	US
Telephone Number	:	718-369-8000
Fax Number	:	718-679-9341

Provider Business Practice Location Address
First Line	:	4911 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3135
Country	:	US
Telephone Number	:	718-431-0073
Fax Number	:	718-431-0099

Authorized Official
Title or Position	:	MANAGER
Name	:	EUDELL HAYES
Credential	:
Telephone Number	:	718-369-8000

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	09/11/2009

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