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NPI Code Detail

MEDICARE: PREMIER ORTHOPEDICS & SPORTS MEDICINE

MEDICARE: PREMIER ORTHOPEDICS & 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
1174400000XSpecialist

General Provider Information

NPI Number : 1629195417
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER ORTHOPEDICS & SPORTS MEDICINE
Provider Business Mailing Address
First Line : 2705 WILLIAMSBRIDGE RD
Second Line :
City : BRONX
State : NY
Zip : 10469-4109
Country : US
Telephone Number : 718-515-9800
Fax Number : 718-231-7942
Provider Business Practice Location Address
First Line : 2705 WILLIAMSBRIDGE RD
Second Line :
City : BRONX
State : NY
Zip : 10469-4109
Country : US
Telephone Number : 718-515-9800
Fax Number : 718-231-7942
Authorized Official
Title or Position : PRESIDENT
Name : MEENA BANSAL
Credential :
Telephone Number : 718-515-9800
Provider Enumeration Date : 03/25/2007
Last Update Date : 08/22/2020

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Directions to “PREMIER ORTHOPEDICS & SPORTS MEDICINE ” Practice Location

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