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General NPI Number Information
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NPI Number | 1760775308
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Entity Type | Organization
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Legal Business Name | SPORTS INJURIES & ARTHRITIS SURGERY, PC
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 942 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10021-2656
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Country | US
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Telephone | 212-988-9400
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Fax | 212-249-5463
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Provider Business Mailing Address
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Address Line | 942 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10021-2656
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Country | US
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Telephone | 212-988-9400
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Fax | 212-249-5463
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID JONATHAN FLEISS
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Credential | MD
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Telephone | 212-988-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 127297
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License Number State | NY
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