Provider Demographics
NPI:1801064167
Name:FITNESS & RECOVERY, LLC
Entity type:Organization
Organization Name:FITNESS & RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MACK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-395-3691
Mailing Address - Street 1:150 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-3306
Mailing Address - Country:US
Mailing Address - Phone:914-395-3691
Mailing Address - Fax:914-395-3693
Practice Address - Street 1:150 LAKE AVE
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3306
Practice Address - Country:US
Practice Address - Phone:914-395-3691
Practice Address - Fax:914-395-3693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203477207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Single Specialty