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CONCOURSE SURGICAL SPORT SUPPLY, INC.
NPI 1912910571
Durable Medical Equipment & Medical Supplies - Customized Equipment in New York, NY

Active since August 14, 2006
5049 BROADWAY, NEW YORK, NY 10034(212) 569-2635(212) 569-2639 Get Directions Write a Review

NPPES record last updated: October 5, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 5, 2020, Aug 22, 2020 (2 updates tracked since 2020).

About Concourse Surgical Sport Supply, Inc. NPPES

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

CONCOURSE SURGICAL SPORT SUPPLY, INC. (NPI 1912910571) is a healthcare organization registered as a customized equipment in New York, New York and active in the NPI registry since August 2006. The organization lists Nidia Pena, Manager, as its authorized official.

NPPES Registry Identity

NPI1912910571
Entity TypeOrganization
Primary Taxonomy332BC3200X
Legal Business NameCONCOURSE SURGICAL SPORT SUPPLY, INC.
Location Address5049 BROADWAYNew York, NY 10034-1131
Mailing Address8 Edgewood DrOrangeburg, NY 10962-1604 · (212) 569-2635 · Fax (212) 569-2639
Phone(212) 569-2635
Fax(212) 569-2639
Organization SubpartNo
Authorized OfficialNidia PenaManager · (212) 569-2635
Enumeration DateAugust 14, 2006
Last NPPES UpdateOctober 5, 20202 updates tracked since enumeration
NPPES CertifiedOctober 5, 2020
✔ NPI 1912910571 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDurable Medical Equipment & Medical Supplies · Customized EquipmentSuppliers
Taxonomy Code332BC3200X
5049 BROADWAY, New York, NY 10034
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Other Identifiers 1

Medicaid01785982NY

Other Providers at the Same Location NPPES

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

DYNAMIC PHYSICAL THERAPY AND SPORTS REHAB
Clinic/Center (Physical Therapy)
5049 BROADWAY
NEW YORK, NY 10034
New York County (213) 884-5987

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 Concourse Surgical Sport Supply, Inc.'s NPI number?

The NPI number for Concourse Surgical Sport Supply, Inc. is 1912910571. It was assigned to this organization in the NPPES registry on August 14, 2006.

Where is Concourse Surgical Sport Supply, Inc. located?

Concourse Surgical Sport Supply, Inc. is located at 5049 Broadway, New York, NY 10034. The listed phone number is (212) 569-2635.

What is Concourse Surgical Sport Supply, Inc.'s specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies, specializing in Customized Equipment, with taxonomy code 332BC3200X.

When was this NPI record last updated?

The NPPES record for Concourse Surgical Sport Supply, Inc. was last updated on October 5, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.