Healthcare Provider Details

I. General information

NPI: 1255436663
Provider Name (Legal Business Name): METRO ATHLETIC MEDICINE & FITNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 7TH AVENUE SUITE 2A
BROOKLYN NY
11215-3689
US

IV. Provider business mailing address

263 7TH AVENUE SUITE 2A
BROOKLYN NY
11215-3689
US

V. Phone/Fax

Practice location:
  • Phone: 718-369-8000
  • Fax: 718-679-9598
Mailing address:
  • Phone: 718-369-8000
  • Fax: 718-679-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. EUDELL C HAYES
Title or Position: EXECUTIVE MANAGER
Credential:
Phone: 718-369-8000