Healthcare Provider Details

I. General information

NPI: 1487809232
Provider Name (Legal Business Name): RICHARD A GASALBERTI M D SPORTS MEDICINE & REHABILITATION P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 QUEENS BLVD
FOREST HILLS NY
11375-6341
US

IV. Provider business mailing address

11120 QUEENS BLVD
FOREST HILLS NY
11375-6341
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-7700
  • Fax: 718-793-2942
Mailing address:
  • Phone: 718-544-7700
  • Fax: 718-793-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number176219
License Number StateNY

VIII. Authorized Official

Name: RICHARD GASALBERTI
Title or Position: DELEGATED OFFICIAL
Credential: MD
Phone: 718-544-7700