Healthcare Provider Details

I. General information

NPI: 1124081815
Provider Name (Legal Business Name): CMORS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 GRAND CONCOURSE SUITE-BASEMENT
BRONX NY
10468-1138
US

IV. Provider business mailing address

3235 GRAND CONCOURSE SUITE-BASEMENT
BRONX NY
10468-1138
US

V. Phone/Fax

Practice location:
  • Phone: 718-367-8800
  • Fax: 718-367-4047
Mailing address:
  • Phone: 718-367-8800
  • Fax: 718-367-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number210513
License Number StateNY

VIII. Authorized Official

Name: MRS. SYLVIA LINSALATO
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 718-367-8800