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General NPI Number Information
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NPI Number | 1457988115
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Entity Type | Individual
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Provider Name | LEA GEORGATOS ATC
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 4513 MANHATTAN COLLEGE PKWY
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City | BRONX
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State | NY
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Zip | 10471-4004
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Country | US
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Telephone | 718-826-7226
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Fax |
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Provider Business Mailing Address
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Address Line | 218 HASBROUCK AVE
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City | EMERSON
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State | NJ
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Zip | 07630-1162
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Country | US
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Telephone | 201-906-3927
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00269500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 003935
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000037008
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License Number State |
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