Provider Demographics
NPI:1407171564
Name:SPINE SPRORTS OCCUPATIONAL REHAB
Entity Type:Organization
Organization Name:SPINE SPRORTS OCCUPATIONAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:VARLOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-263-6062
Mailing Address - Street 1:317 E 34TH ST
Mailing Address - Street 2:5TH FLR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4974
Mailing Address - Country:US
Mailing Address - Phone:212-263-6062
Mailing Address - Fax:212-686-1927
Practice Address - Street 1:317 E 34TH ST
Practice Address - Street 2:5TH FLR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4974
Practice Address - Country:US
Practice Address - Phone:212-263-6062
Practice Address - Fax:212-686-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty