Organization
SPORTS MEDICINE NORTH ORTHOPAEDIC SURGERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY A POLANSKY MD (PRESIDENT)
(978) 818-6350
Entity
Organization
Contact information
Practice address
1 BLACKBURN DR, SUITE 5, GLOUCESTER, MA 01930-2237
(978) 818-6350
(978) 818-6355
Mailing address
1 ORTHOPEDICS DR, PEABODY, MA 01960-1668
(978) 818-6350
(978) 818-6355
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9773363
—
MA
01
—
M15814
MEDICARE
MA
Enumeration date
09/14/2011
Last updated
04/11/2013
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