Provider Demographics
NPI:1629493705
Name:BROOKLYN ORTHOPEDIC AND SPORTS MEDICINE PLLC
Entity Type:Organization
Organization Name:BROOKLYN ORTHOPEDIC AND SPORTS MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CALOGERO
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-755-6147
Mailing Address - Street 1:84 80TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3512
Mailing Address - Country:US
Mailing Address - Phone:718-755-6147
Mailing Address - Fax:
Practice Address - Street 1:263 7TH AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7247
Practice Address - Country:US
Practice Address - Phone:718-246-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249800207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty