| The Sports Medical Zone Pllc | |
|
60 College Ave Nanuet NY 10954-3010 | |
| (845) 579-2700 | |
| Not Available |
| Full Name | The Sports Medical Zone Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 60 College Ave, Nanuet, New York |
| Authorized Official Name and Position | Mckirven Ceus (OWNER) |
| Authorized Official Contact | 8454055311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Sports Medical Zone Pllc 60 College Ave Nanuet NY 10954-3010 Ph: (845) 579-2700 | The Sports Medical Zone Pllc 60 College Ave Nanuet NY 10954-3010 Ph: (845) 579-2700 |
| NPI Number | 1154959427 |
|---|---|
| Provider Enumeration Date | 03/31/2020 |
| Last Update Date | 03/31/2020 |
| Medicare PECOS PAC ID | 9133550387 |
|---|---|
| Medicare Enrollment ID | O20200504001262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154959427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Alyssa Ciceron |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1447620455 PECOS PAC ID: 6002116399 Enrollment ID: I20151118000316 |
| Provider Name | Mckirven Ceus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295154730 PECOS PAC ID: 2163648320 Enrollment ID: I20180510000896 |
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