Healthcare Provider Details

I. General information

NPI: 1740516897
Provider Name (Legal Business Name): ENDURANCE SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 WHITEHORSE MERCERVILLE RD
HAMILTON NJ
08619-3814
US

IV. Provider business mailing address

1230 WHITEHORSE MERCERVILLE RD
HAMILTON NJ
08619-3814
US

V. Phone/Fax

Practice location:
  • Phone: 609-581-1700
  • Fax:
Mailing address:
  • Phone: 609-581-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08329600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number25MA08329600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier25MA08329600
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICAL LIC
# 2
IdentifierD09206900
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerCDS

VIII. Authorized Official

Name: DR. CHARLES E FLORES
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 609-581-1700