Advantage Sports Medicine LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

25 MB07982100 Issued in NJ

Legal business name

ADVANTAGE SPORTS MEDICINE LLC

Practice address

67 Broadway
Elmwood Park, NJ 07407-1836

Phone

(201) 569-0010

NPI assigned

Oct 1, 2013

Last updated

Jan 21, 2014By 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

Thomas S Bottiglieri, D.O.

Title

Owner/Physician

Phone

(201) 569-0010

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390262400000",
    "number": "1922435395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70176",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103070176",
            "telephone_number": "718-984-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 BROADWAY",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074071836",
            "telephone_number": "201-569-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-01",
        "last_updated": "2014-01-21",
        "status": "A",
        "authorized_official_last_name": "BOTTIGLIERI",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "201-569-0010",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NJ",
            "license": "25 MB07982100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Elmwood Park, NJ
• Providers in Elmwood Park, NJ by specialty
• Multi-Specialty Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2014; 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.