Sports Extra PC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

SPORTS EXTRA PC

Practice address

67 Walnut Ave
Suite 202
Clark, NJ 07066-1640

Phone

(732) 388-7300

Fax

(732) 388-1330

NPI assigned

May 25, 2006

Last updated

Oct 18, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michele Theresa Gilsenan, D.O.NPI 1821066283

Title

Practice Owner

Phone

(732) 388-7300

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michele Theresa Gilsenan, D.O.

  • Sports Medicine (Family Medicine) Physician
  • Clark, NJ
  • NPI 1821066283
  NPD (past) Authorized official
• Peter Frances Barry, D.O.

  • Internal Medicine Physician
  • Clark, NJ
  • NPI 1609844828
  NPD (past)
• Michael Elliot Beams, D.O.

  • Sports Medicine (Family Medicine) Physician
  • Clark, NJ
  • NPI 1184692261
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192665600000",
    "number": "1346296969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 WALNUT AVE",
            "address_2": "SUITE 202",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661640",
            "telephone_number": "732-388-7300",
            "fax_number": "732-388-1330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 WALNUT AVE",
            "address_2": "SUITE 202",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661640",
            "telephone_number": "732-388-7300",
            "fax_number": "732-388-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS EXTRA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2007-10-18",
        "status": "A",
        "authorized_official_last_name": "GILSENAN",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "THERESA",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "732-388-7300",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jody Skariah, M.D.
• Matthew Skoblar, D.O.
• Kerianne Skobo, KERIANNE SKOBO
• Lukasz Sliwa
• Gara Sommers, M.D.
• Brittany Stallone
• Nicholas M Stanco, LPC
• Jessica Stanton, PHARMD
• Jennifer Lynn Stautz, ATC
• Suarez Osteopathic Medicine

• Sports Medicine (Family Medicine) Physician in Clark, NJ
• Providers in Clark, NJ by specialty
• Sports Medicine (Family Medicine) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.