Provider Demographics
NPI:1396066320
Name:NY SPORTSMED AND PHYSICAL THERAPY
Entity type:Organization
Organization Name:NY SPORTSMED AND PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-750-1110
Mailing Address - Street 1:18 E 48TH ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1014
Mailing Address - Country:US
Mailing Address - Phone:212-750-1110
Mailing Address - Fax:212-750-1170
Practice Address - Street 1:1841 BROADWAY
Practice Address - Street 2:SUITE 1100
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7603
Practice Address - Country:US
Practice Address - Phone:212-245-5500
Practice Address - Fax:212-245-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2011-01-07
Deactivation Date:2010-11-11
Deactivation Code:
Reactivation Date:2011-01-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty