Provider Demographics
NPI:1144231226
Name:SPORTS MEDICINE AT CHELSEA, PLLC.
Entity Type:Organization
Organization Name:SPORTS MEDICINE AT CHELSEA, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:D
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-366-5100
Mailing Address - Street 1:30 W 24TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3560
Mailing Address - Country:US
Mailing Address - Phone:212-366-5100
Mailing Address - Fax:212-366-6275
Practice Address - Street 1:30 W 24TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3560
Practice Address - Country:US
Practice Address - Phone:212-366-5100
Practice Address - Fax:212-366-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2247351207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5178B1Medicare ID - Type Unspecified
NYH48841Medicare UPIN