Provider Demographics
NPI:1538670666
Name:CONCUSSION MANAGEMENT OF NEW YORK
Entity type:Organization
Organization Name:CONCUSSION MANAGEMENT OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:212-717-8331
Mailing Address - Street 1:248 E 73RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4303
Mailing Address - Country:US
Mailing Address - Phone:212-717-8330
Mailing Address - Fax:212-717-6235
Practice Address - Street 1:215 E 73RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3653
Practice Address - Country:US
Practice Address - Phone:212-717-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty