Provider Demographics
NPI:1811028210
Name:CENTER FOR SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:CENTER FOR SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:I
Authorized Official - Last Name:MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-777-0934
Mailing Address - Street 1:1300 MAIN AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2244
Mailing Address - Country:US
Mailing Address - Phone:973-777-0934
Mailing Address - Fax:973-773-0543
Practice Address - Street 1:1300 MAIN AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2244
Practice Address - Country:US
Practice Address - Phone:973-777-0934
Practice Address - Fax:973-773-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA075674002081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096802Medicare ID - Type Unspecified
NJH82983Medicare UPIN