Healthcare Provider Details

I. General information

NPI: 1861837015
Provider Name (Legal Business Name): SPORTS MEDICINE NORTH ORTHOPAEDIC SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 1ST AVE SUITE 211
PEABODY MA
01960-4959
US

IV. Provider business mailing address

1 ORTHOPEDICS DR 2ND FLOOR
PEABODY MA
01960-1668
US

V. Phone/Fax

Practice location:
  • Phone: 978-535-1213
  • Fax:
Mailing address:
  • Phone: 978-818-6350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY POLANSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-818-6350