| Sports Extra Pc | |
|
67 Walnut Ave Suite 202 Clark NJ 07066-1640 | |
| (732) 388-7300 | |
| (732) 388-1330 |
| Full Name | Sports Extra Pc |
|---|---|
| Speciality | Family Medicine - Sports Medicine |
| Location | 67 Walnut Ave, Clark, New Jersey |
| Authorized Official Name and Position | Michele Theresa Gilsenan (PRACTICE OWNER) |
| Authorized Official Contact | 7323887300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sports Extra Pc 67 Walnut Ave Suite 202 Clark NJ 07066-1640 Ph: (732) 388-7300 | Sports Extra Pc 67 Walnut Ave Suite 202 Clark NJ 07066-1640 Ph: (732) 388-7300 |
| NPI Number | 1346296969 |
|---|---|
| Provider Enumeration Date | 05/25/2006 |
| Last Update Date | 10/18/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346296969 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
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