1. Home
  2. Directory
  3. New Jersey
  4. Clark
  5. Family Medicine
  6. NPI Profile

SPORTS EXTRA PC
NPI 1346296969
Family Medicine - Sports Medicine in Clark, NJ

Active since May 25, 2006
67 WALNUT AVE, SUITE 202, CLARK, NJ 07066(732) 388-7300(732) 388-1330 Get Directions Write a Review

NPPES record last updated: October 18, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Sports Extra Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SPORTS EXTRA PC (NPI 1346296969) is a healthcare organization registered as a sports medicine in Clark, New Jersey and active in the NPI registry since May 2006. The organization lists Michele Theresa Gilsenan, Practice Owner, as its authorized official.

NPPES Registry Identity

NPI1346296969
Entity TypeOrganization
Primary Taxonomy207QS0010X
Legal Business NameSPORTS EXTRA PC
Location Address67 WALNUT AVE, SUITE 202Clark, NJ 07066-1640
Mailing Address67 Walnut Ave, Suite 202Clark, NJ 07066-1640 · (732) 388-7300 · Fax (732) 388-1330
Phone(732) 388-7300
Fax(732) 388-1330
Organization SubpartNo
Authorized OfficialMichele Theresa GilsenanPractice Owner · (732) 388-7300
Enumeration DateMay 25, 2006
Last NPPES UpdateOctober 18, 2007
✔ NPI 1346296969 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QS0010X
Definition
A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
67 WALNUT AVE, Clark, NJ 07066
Open in Google Maps ↗

Other Identifiers 1

Medicare PIN091807NJ

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WALEED IJAZ DO
Family Medicine
67 WALNUT AVE
CLARK, NJ 07066
Union County (732) 388-7300
HEARING HEALTH PA LLC
Hearing Instrument Specialist
67 WALNUT AVE, SUITE 303
CLARK, NJ 07066
Union County (732) 882-7900
SUMMIT MEDICAL GROUP PA
Durable Medical Equipment & Medical Supplies
67 WALNUT AVE
CLARK, NJ 07066
Union County (908) 722-1220
THERACARE OF NEW JERSEY LLC
Community/Behavioral Health
67 WALNUT AVE, SUITE 306
CLARK, NJ 07066
Union County (888) 311-2611
MICHAEL ELLIOT BEAMS D.O.
Family Medicine (Sports Medicine)
67 WALNUT AVE
CLARK, NJ 07066
Union County (732) 388-7300
DR. MICHAEL GENEREUX D.O.
Family Medicine
67 WALNUT AVE
CLARK, NJ 07066
Union County (732) 388-7300
KENNETH Y. ENG, M.D., P.A.
Ophthalmology
67 WALNUT AVE, SUITE 302
CLARK, NJ 07066
Union County (732) 882-0700
MICHELLE POFF LAC
Counselor (Mental Health)
67 WALNUT AVE
CLARK, NJ 07066
Union County (855) 545-4662

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sports Extra PC's NPI number?

The NPI number for Sports Extra PC is 1346296969. It was assigned to this organization in the NPPES registry on May 25, 2006.

Where is Sports Extra PC located?

Sports Extra PC is located at 67 Walnut Ave Suite 202, Clark, NJ 07066. The listed phone number is (732) 388-7300.

What is Sports Extra PC's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

When was this NPI record last updated?

The NPPES record for Sports Extra PC was last updated on October 18, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.