MEDICARE: ATLANTIC SPORTS MEDICINE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	0190041	NY

General Provider Information

NPI Number	:	1356573851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	2428 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3509
Country	:	US
Telephone Number	:	718-934-7770
Fax Number	:	718-934-8038

Provider Business Practice Location Address
First Line	:	2428 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3509
Country	:	US
Telephone Number	:	718-934-7770
Fax Number	:	718-934-8038

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PUSHP BHANSALI
Credential	:	MD
Telephone Number	:	718-934-7770

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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Directions to “ATLANTIC SPORTS MEDICINE ” Practice Location

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