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General NPI Number Information
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NPI Number | 1003114281
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE CONCEPTS, INC
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 03/11/2011
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Provider Practice Location Address
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Address Line | 30 COMMERCIAL AVE SUITE 4
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City | LIVONIA
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State | NY
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Zip | 14487
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Country | US
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Telephone | 585-346-0240
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Fax | 585-346-9764
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Provider Business Mailing Address
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Address Line | 30 COMMERCIAL AVE SUITE 4
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City | LIVONIA
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State | NY
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Zip | 14487
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Country | US
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Telephone | 585-346-0240
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Fax | 585-346-9764
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL JAMES CENDOMA
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Credential | ATC
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Telephone | 585-346-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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