Provider Demographics
NPI:1396987715
Name:A ATHLETE SPORTS MEDICINE, L.L.C.
Entity type:Organization
Organization Name:A ATHLETE SPORTS MEDICINE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:REDLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-790-1272
Mailing Address - Street 1:38 ROBBINSVILLE ALLENTOWN RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1400
Mailing Address - Country:US
Mailing Address - Phone:609-970-1272
Mailing Address - Fax:
Practice Address - Street 1:38 ROBBINSVILLE ALLENTOWN RD STE A
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1400
Practice Address - Country:US
Practice Address - Phone:609-970-1272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07522900207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty