MEDICARE: SPINE AND SPORTS MEDICINE OF NEW YORK PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A228647-1	NY
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A220814-1	NY

General Provider Information

NPI Number	:	1467754416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE AND SPORTS MEDICINE OF NEW YORK PC

Provider Business Mailing Address
First Line	:	820 2ND AVE
Second Line	:	SUITE 6D
City	:	NEW YORK
State	:	NY
Zip	:	10017-4504
Country	:	US
Telephone Number	:	212-682-6970
Fax Number	:	212-682-6979

Provider Business Practice Location Address
First Line	:	820 2ND AVE
Second Line	:	SUITE 6D
City	:	NEW YORK
State	:	NY
Zip	:	10017-4504
Country	:	US
Telephone Number	:	212-682-6970
Fax Number	:	212-682-6979

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDRE PANAGOS
Credential	:	M.D.
Telephone Number	:	212-682-6970

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	10/03/2012

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