Fitness and Recovery Medical Practice, PC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

018927-1 Issued in NY

Legal business name

FITNESS AND RECOVERY MEDICAL PRACTICE, PC

Practice address

369 White Plains Rd
Eastchester, NY 10709-2805

Phone

(914) 395-3691

NPI assigned

Aug 20, 2015

Organization subpart

No

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

Authorized official

Name

Mack Lee Sullivan, MD

Title

Director of Operations

Phone

(914) 395-3691

Specialties & licenses 1

Addresses

Tax ID family

Fitness Recovery Medical P2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fitness and Recovery Medical Practice

  • Physical Therapy Clinic/Center
  • Eastchester, NY
  • NPI 1144633637
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mack Lee Sullivan, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Eastchester, NY
  • NPI 1881616068
  NPD (past)

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440028800000",
    "number": "1811363161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "369 WHITE PLAINS RD",
            "city": "EASTCHESTER",
            "state": "NY",
            "postal_code": "107092805",
            "telephone_number": "914-395-3691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 WHITE PLAINS RD",
            "city": "EASTCHESTER",
            "state": "NY",
            "postal_code": "107092805",
            "telephone_number": "914-395-3691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FITNESS AND RECOVERY MEDICAL PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2015-08-20",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MACK LEE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "914-395-3691",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018927-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerrian Ferguson
• Lisa Ferrauto, MS ED
• Brian Harris Finn, DDS
• Fitness & Recovery Medical Practice, PC
• Fitness and Recovery Medical Practice
• Rosanna Forgione
• Patricia A Foxman, MD
• Alyssa Gaiser, LCSW
• Kaicee Gallo
• Joyce Gambardella, MA CCC-SLP

• Physician Assistant in Eastchester, NY
• Providers in Eastchester, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2015; 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.