Individual
LEA GEORGATOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
4513 MANHATTAN COLLEGE PKWY, BRONX, NY 10471-4004
(718) 826-7226
Mailing address
218 HASBROUCK AVE, EMERSON, NJ 07630-1162
(201) 906-3927
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
003935
NY
2255A2300X
Athletic Trainer
Primary
2000037008
—
2255A2300X
Athletic Trainer
25MT00269500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003935
NEW YORK STATE EDUCATION DEPARTMENT - OFFICE OF THE PROFESSIONS
NY
01
—
2000037008
BOARD OF CERTIFICATION
—
01
—
25MT00269500
STATE OF NEW JERSEY / NEW JERSEY DIVISION OF CONSUMER AFFAIRS
NJ
Enumeration date
03/24/2020
Last updated
03/24/2020
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