Provider Demographics
NPI:1356573851
Name:ATLANTIC SPORTS MEDICINE
Entity type:Organization
Organization Name:ATLANTIC SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PUSHP
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANSALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-934-7770
Mailing Address - Street 1:2428 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3509
Mailing Address - Country:US
Mailing Address - Phone:718-934-7770
Mailing Address - Fax:718-934-8038
Practice Address - Street 1:2428 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3509
Practice Address - Country:US
Practice Address - Phone:718-934-7770
Practice Address - Fax:718-934-8038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0190041208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty