Provider Demographics
NPI:1558514182
Name:METRO ATHLETIC MEDICINE&FITNESS PC
Entity Type:Organization
Organization Name:METRO ATHLETIC MEDICINE&FITNESS PC
Other - Org Name:METRO SPORTSMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EUDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-369-8000
Mailing Address - Street 1:263 7TH AVE
Mailing Address - Street 2:2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3689
Mailing Address - Country:US
Mailing Address - Phone:718-369-8000
Mailing Address - Fax:718-679-9341
Practice Address - Street 1:44 LEE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7216
Practice Address - Country:US
Practice Address - Phone:718-963-0882
Practice Address - Fax:718-963-0885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROSPORTSMED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q4WAC1Medicare PIN