MEDICARE: DAN TRINH ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	RT005936	PA

General Provider Information

NPI Number	:	1457760647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAN TRINH ATC

Provider Business Mailing Address
First Line	:	819 1ST ST
Second Line	:
City	:	SECAUCUS
State	:	NJ
Zip	:	07094-3401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 CONSTITUTION ST
Second Line	:
City	:	PERRYOPOLIS
State	:	PA
Zip	:	15473-1390
Country	:	US
Telephone Number	:	201-450-7363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	08/13/2014

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Directions to “ DAN TRINH ATC” Practice Location

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