Organization
SPORTS MANAGEMENT INSTITUTE LLC
Active
Other names
Sports Medicine 360 LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DINA DEGREGORIO (MANAGER)
(973) 748-0067
Entity
Organization
Contact information
Practice address
14-20 WATSESSING AVE, BLOOMFIELD, NJ 07003-4611
(973) 748-0067
Mailing address
14-20 WATSESSING AVE, BLOOMFIELD, NJ 07003-4611
(973) 748-0067
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
0400560133
NJ
Other
Enumeration date
07/12/2013
Last updated
07/12/2013
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