Provider Demographics
NPI:1023520871
Name:ATHLETES PERFORMANCE CARE
Entity type:Organization
Organization Name:ATHLETES PERFORMANCE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:631-235-1020
Mailing Address - Street 1:112 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3125
Mailing Address - Country:US
Mailing Address - Phone:631-235-1020
Mailing Address - Fax:631-563-7599
Practice Address - Street 1:112 ELM ST
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-3125
Practice Address - Country:US
Practice Address - Phone:631-235-1020
Practice Address - Fax:631-563-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023365225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty