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General NPI Number Information
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NPI Number | 1992972004
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Entity Type | Organization
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Legal Business Name | SPINE SPORTS OCCUPATIONAL REHABILITATION ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 317 E 34TH ST 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10016-4974
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Country | US
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Telephone | 212-263-6062
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Fax | 212-263-6096
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Provider Business Mailing Address
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Address Line | 317 E 34TH ST 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10016-4974
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Country | US
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Telephone | 212-263-6062
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Fax | 212-263-6096
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Authorized Official
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Title or Position | OWNER
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Name | GERARD PHILIP VARLOTTA
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Credential | DO
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Telephone | 212-263-6062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2081P0004X
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Taxonomy Name | Spinal Cord Injury Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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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 |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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