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General NPI Number Information
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NPI Number | 1861731036
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Entity Type | Organization
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Legal Business Name | KM SPORTS AND SPINE MEDICINE
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 444 MARKET ST
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5996
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Country | US
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Telephone | 201-632-3080
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Fax | 201-644-6269
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Provider Business Mailing Address
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Address Line | 444 MARKET ST SUITE 2B
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5996
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Country | US
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Telephone | 201-632-3080
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Fax | 201-644-6269
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN MCELROY
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Credential | DO
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Telephone | 201-632-3080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MB08770900
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License Number State | NJ
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