Healthcare Provider Details

I. General information

NPI: 1609919695
Provider Name (Legal Business Name): JAMES D GOSSETT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 BROADWAY MC 1915 COLUMBIA UNIVERSITY
NEW YORK NY
10027-1915
US

IV. Provider business mailing address

7 BONAVENTURE AVE
ARDSLEY NY
10502-2103
US

V. Phone/Fax

Practice location:
  • Phone: 212-854-3178
  • Fax: 212-854-4597
Mailing address:
  • Phone: 914-693-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000016-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: