Healthcare Provider Details

I. General information

NPI: 1275955718
Provider Name (Legal Business Name): FAMILY HEALTH & SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RESERVOIR AVE
CRANSTON RI
02910-4448
US

IV. Provider business mailing address

725 RESERVOIR AVE
CRANSTON RI
02910-4448
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-6910
  • Fax: 401-946-5130
Mailing address:
  • Phone: 401-943-6910
  • Fax: 401-946-5130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT J PUERINI JR.
Title or Position: MEMBER
Credential: MD
Phone: 401-943-6910