Healthcare Provider Details

I. General information

NPI: 1396066320
Provider Name (Legal Business Name): NY SPORTSMED AND PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date: 11/11/2010
Reactivation Date: 01/07/2011

III. Provider practice location address

1841 BROADWAY SUITE 1100
NEW YORK NY
10023-7603
US

IV. Provider business mailing address

18 E 48TH ST SUITE 901
NEW YORK NY
10017-1014
US

V. Phone/Fax

Practice location:
  • Phone: 212-245-5500
  • Fax: 212-245-5540
Mailing address:
  • Phone: 212-750-1110
  • Fax: 212-750-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM BANKS
Title or Position: CEO
Credential:
Phone: 212-750-1110