Healthcare Provider Details

I. General information

NPI: 1366713216
Provider Name (Legal Business Name): SCOTT DAMIAN HOAGLAND ATC,LAT,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 S FINLEY AVE
BASKING RIDGE NJ
07920-1435
US

IV. Provider business mailing address

162 KINGSBURY CT
NAZARETH PA
18064-1121
US

V. Phone/Fax

Practice location:
  • Phone: 908-204-2585
  • Fax:
Mailing address:
  • Phone: 610-746-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00077500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: