Provider Demographics
NPI:1376719823
Name:WESTSIDE SPINE AND SPORTS MEDICINE, P. C.
Entity Type:Organization
Organization Name:WESTSIDE SPINE AND SPORTS MEDICINE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:REALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-262-7246
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:212-262-7246
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:212-262-7246
Practice Address - Fax:212-262-9178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty