Healthcare Provider Details

I. General information

NPI: 1487960738
Provider Name (Legal Business Name): NEW YORK SOCIETY FOR THE RELIEF OF THE RUPTURED AND CRIPPLED MAINTAINI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

45 OSBORNE HILL RD
SANDY HOOK CT
06482-1544
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1224
  • Fax:
Mailing address:
  • Phone: 203-426-0719
  • Fax: 413-460-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD CROWLEY
Title or Position: VP OF PHYSICIAN SERVICES
Credential:
Phone: 212-606-1224