Concourse Surgical Sport Supply, Inc.

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

CONCOURSE SURGICAL SPORT SUPPLY, INC.

Practice address

5049 Broadway
New York, NY 10034-1131

Phone

(212) 569-2635

Fax

(212) 569-2639

NPI assigned

Aug 14, 2006

Organization subpart

No

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

Authorized official

Name

Nidia Pena

Title

Manager

Phone

(212) 569-2635

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601856000000",
    "number": "1912910571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 EDGEWOOD DR",
            "city": "ORANGEBURG",
            "state": "NY",
            "postal_code": "109621604",
            "telephone_number": "212-569-2635",
            "fax_number": "212-569-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5049 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100341131",
            "telephone_number": "212-569-2635",
            "fax_number": "212-569-2639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCOURSE SURGICAL SPORT SUPPLY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "NIDIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "212-569-2635"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01785982",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Customized Equipment (DME) in New York, NY
• Providers in New York, NY by specialty
• Customized Equipment (DME) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.

Verify at the official NPI Registry.