MEDICARE: CONCUSSION MANAGEMENT OF NEW YORK

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	2251N0400X	Neurology Physical Therapist

General Provider Information

NPI Number	:	1538670666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCUSSION MANAGEMENT OF NEW YORK

Provider Business Mailing Address
First Line	:	248 E 73RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4303
Country	:	US
Telephone Number	:	212-717-8330
Fax Number	:	212-717-6235

Provider Business Practice Location Address
First Line	:	215 E 73RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3653
Country	:	US
Telephone Number	:	212-717-8331
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/CLINICIAN
Name	:	DR. ALEX GOMETZ
Credential	:	DPT
Telephone Number	:	212-717-8331

Provider Enumeration Date	:	10/16/2017
Last Update Date	:	10/16/2017

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Directions to “CONCUSSION MANAGEMENT OF NEW YORK ” Practice Location

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