Healthcare Provider Details

I. General information

NPI: 1821499765
Provider Name (Legal Business Name): NEW YORK SOCIETY FOR THE RELIEF OF THE RUPTURED AND CRIPPLED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST ATTENTION: CATHERINE LEE
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

140 E RIDGEWOOD AVE 175 SOUTH
PARAMUS NJ
07652-3917
US

V. Phone/Fax

Practice location:
  • Phone: 212-774-7598
  • Fax:
Mailing address:
  • Phone: 212-774-7598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number700201211
License Number StateNY

VIII. Authorized Official

Name: MR. RICHARD G CROWLEY
Title or Position: VICE PRESIDENT OF PHYSICIAN SERVICE
Credential:
Phone: 212-606-1224