Provider Demographics
NPI:1700039336
Name:METRO ATHLETIC MEDICINE &FITNESS PC
Entity Type:Organization
Organization Name:METRO ATHLETIC MEDICINE &FITNESS PC
Other - Org Name:METRO SPORTSMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EUDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-369-8000
Mailing Address - Street 1:263 7TH AVE
Mailing Address - Street 2:2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3689
Mailing Address - Country:US
Mailing Address - Phone:718-369-8000
Mailing Address - Fax:718-369-8011
Practice Address - Street 1:1309 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3605
Practice Address - Country:US
Practice Address - Phone:718-677-7680
Practice Address - Fax:718-677-6586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO ATHLETIC MEDICINE &FITNESS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6167590006Medicare NSC
NYQ4WAC1Medicare PIN