Healthcare Provider Details

I. General information

NPI: 1497059901
Provider Name (Legal Business Name): MICHAEL J NEELY DO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 BROADWAY SUITE 200
NEW YORK NY
10003-4703
US

IV. Provider business mailing address

853 BROADWAY SUITE 200
NEW YORK NY
10003-4703
US

V. Phone/Fax

Practice location:
  • Phone: 212-750-1110
  • Fax: 212-750-1140
Mailing address:
  • Phone: 212-750-1110
  • Fax: 212-750-1140

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: ADAM A BANKS
Title or Position: CEO
Credential:
Phone: 212-750-1110