Provider Demographics
NPI:1851484380
Name:SPORTSCARE OF AMERICA, PC
Entity Type:Organization
Organization Name:SPORTSCARE OF AMERICA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ALTAGRACIA
Authorized Official - Last Name:LANTIGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-887-9000
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:11 EAGLE ROCK AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3167
Practice Address - Country:US
Practice Address - Phone:973-887-0115
Practice Address - Fax:973-887-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00609800225100000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDF647OtherRAILROAD MEDICARE
NJ108382Medicare PIN
NJDF647OtherRAILROAD MEDICARE