Sports Extra PC
NPI #1346296969 in Clark, New Jersey
Provider Information
- NPI Number
- 1346296969
- Entity Type
- Organization
- Organization Name
- Sports Extra PC
- Primary Specialty
- Family Medicine - Sports Medicine
- Enumeration Date
- May 25, 2006
- Last Updated
- Oct 18, 2007
Practice Location
- Address
- 67 WALNUT AVE
- Address 2
- SUITE 202
- City
- Clark
- State
- New Jersey
- ZIP Code
- 07066-1640
- Phone
- (732) 388-7300
Authorized Official
- Name
- MICHELE THERESA GILSENAN, D.O.
- Title
- PRACTICE OWNER
- Phone
- (732) 388-7300
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine - Sports Medicine — Sports Medicine |
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