MEDICARE: SPORTS & ORTHOPEDIC SURGERY OF NEW YORK, PLLC

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	174400000X	Specialist	217407	NY

General Provider Information

NPI Number	:	1871790071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTS & ORTHOPEDIC SURGERY OF NEW YORK, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 6402
Second Line	:
City	:	ITHACA
State	:	NY
Zip	:	14851-6402
Country	:	US
Telephone Number	:	212-254-0946
Fax Number	:	212-254-0956

Provider Business Practice Location Address
First Line	:	205 E 16TH ST
Second Line	:	SUITE M1B
City	:	NEW YORK
State	:	NY
Zip	:	10003-3746
Country	:	US
Telephone Number	:	212-254-0946
Fax Number	:	212-254-0956

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	IVAN J FERNANDEZ-MADRID
Credential	:	M.D.
Telephone Number	:	212-254-0946

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	03/07/2011

Similar Medicare Providers

1366777112 — DR. SUSAN MARIAN CARROLL PSY.D.
Practice Location Address:

205 E 16TH ST , SUITE M1A
NEW YORK, NY
10003-3746

Practice Phone: 917-238-4814
Practice Fax:

1831419019 — GRAMERCY PSYCHOLOGICAL SERVICES LLC
Practice Location Address:

205 E 16TH ST , SUITE M1A
NEW YORK, NY
10003-3746

Practice Phone: 212-696-7494
Practice Fax: 917-720-9022

1740570233 — MS. FRANCES MELDRIM BOSWELL L.AC
Practice Location Address:

205 E 16TH ST
NEW YORK, NY
10003-3746

Practice Phone: 917-697-9007
Practice Fax:

1699103655 — 16TH STREET ACUPUNCTURE PLLC
Practice Location Address:

205 E 16TH ST , M2A
NEW YORK, NY
10003-3746

Practice Phone: 646-221-6535
Practice Fax:

1740618842 — MS. SAMANTHA YURKOSKY LAC
Practice Location Address:

205 E 16TH ST , M2A
NEW YORK, NY
10003-3746

Practice Phone: 646-221-6535
Practice Fax:

1548691074 — DR. CHARLES AMRHEIN PSYD
Practice Location Address:

205 E 16TH ST , 2C
NEW YORK, NY
10003-3746

Practice Phone: 917-673-6538
Practice Fax:

Directions to “SPORTS & ORTHOPEDIC SURGERY OF NEW YORK, PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.