Provider Demographics
NPI:1497059901
Name:MICHAEL J NEELY DO, PLLC
Entity Type:Organization
Organization Name:MICHAEL J NEELY DO, PLLC
Other - Org Name:NY SPORTSMED AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-750-1110
Mailing Address - Street 1:853 BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4703
Mailing Address - Country:US
Mailing Address - Phone:212-750-1110
Mailing Address - Fax:212-750-1140
Practice Address - Street 1:853 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4703
Practice Address - Country:US
Practice Address - Phone:212-750-1110
Practice Address - Fax:212-750-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty