Provider Demographics
NPI:1326214636
Name:SPORTS & ENTERTAINMENT PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:SPORTS & ENTERTAINMENT PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:N
Authorized Official - Last Name:BAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-262-7282
Mailing Address - Street 1:244 W 54TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5515
Mailing Address - Country:US
Mailing Address - Phone:212-262-7282
Mailing Address - Fax:212-262-9178
Practice Address - Street 1:244 W 54TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5515
Practice Address - Country:US
Practice Address - Phone:212-262-7282
Practice Address - Fax:212-262-9178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1180206OtherUHC MPIN
NY4415388OtherAETNA PIN
NYP1997703OtherOXFORD PIN