Provider Demographics
NPI:1023183985
Name:SPORTS MEDICINE & ORTHOPAEDIC SERVICES OF L.I., P.C.
Entity Type:Organization
Organization Name:SPORTS MEDICINE & ORTHOPAEDIC SERVICES OF L.I., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:YURICIC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-354-9250
Mailing Address - Street 1:1575 HILLSIDE AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2501
Mailing Address - Country:US
Mailing Address - Phone:516-354-9250
Mailing Address - Fax:516-358-5359
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2501
Practice Address - Country:US
Practice Address - Phone:516-354-9250
Practice Address - Fax:516-358-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty