Active NPI
Lea Georgatos, ATC
- Athletic Trainer
- Bronx, NY
National Provider Identifier
1457988115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000037008
- Practice address
- 4513 Manhattan College Pkwy
Bronx, NY 10471-4004 - Phone
- (718) 826-7226
- NPI assigned
- Mar 24, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 25MT00269500 | NJ | |
| Athletic Trainer | 2255A2300X | 003935 | NY | |
| Athletic Trainer | 2255A2300X | 2000037008 | Primary |
Addresses
Primary practice location
4513 Manhattan College Pkwy
Bronx, NY 10471-4004
Mailing address
218 Hasbrouck Ave
Emerson, NJ 07630-1162
Phone (201) 906-3927
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003935 | Other | NY | NEW YORK STATE EDUCATION DEPARTMENT - OFFICE OF THE PROFESSIONS |
| 2000037008 | Other | BOARD OF CERTIFICATION | |
| 25MT00269500 | Other | NJ | STATE OF NEW JERSEY / NEW JERSEY DIVISION OF CONSUMER AFFAIRS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MT00269500 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585008000000",
"number": "1457988115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "218 HASBROUCK AVE",
"city": "EMERSON",
"state": "NJ",
"postal_code": "076301162",
"telephone_number": "201-906-3927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4513 MANHATTAN COLLEGE PKWY",
"city": "BRONX",
"state": "NY",
"postal_code": "104714004",
"telephone_number": "718-826-7226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEORGATOS",
"first_name": "LEA",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-24",
"last_updated": "2020-03-24",
"certification_date": "2020-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "25MT00269500",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "003935",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": "2000037008",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE EDUCATION DEPARTMENT - OFFICE OF THE PROFESSIONS",
"identifier": "003935",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF CERTIFICATION",
"identifier": "2000037008",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF NEW JERSEY / NEW JERSEY DIVISION OF CONSUMER AFFAIRS",
"identifier": "25MT00269500",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.