Provider Demographics
NPI:1275501074
Name:SPORTSCARE INSTITUTE, INC.
Entity Type:Organization
Organization Name:SPORTSCARE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-887-9000
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3101
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3654
Practice Address - Street 1:111 WES WATER STREET
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:973-887-9000
Practice Address - Fax:973-887-3654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA0060980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDC7948Medicare PIN
NJ024010Medicare PIN
NJ022555Medicare PIN
NJDA4878Medicare PIN
NJ4705770002Medicare NSC