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General NPI Number Information
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NPI Number | 1477579332
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Entity Type | Organization
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Legal Business Name | ACTIVE SPORTS MEDICINE & ORTHOPAEDIC SURGERY PC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 757 LINCOLN BLVD
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City | LONG BEACH
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State | NY
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Zip | 11561-2355
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Country | US
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Telephone | 516-432-8800
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Fax | 516-432-8801
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Provider Business Mailing Address
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Address Line | 757 LINCOLN BLVD
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City | LONG BEACH
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State | NY
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Zip | 11561-2355
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Country | US
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Telephone | 516-432-8800
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Fax | 516-432-8801
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Authorized Official
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Title or Position | OFFICER
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Name | BENJAMIN S UH
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Credential | M.D.
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Telephone | 516-432-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 201193
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License Number State | NY
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