Healthcare Provider Details

I. General information

NPI: 1366478075
Provider Name (Legal Business Name): JOSEPH JOHN CAMILLONE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PENNINGTON RD THE COLLEGE OF NEW JERSEY
EWING NJ
08618-1104
US

IV. Provider business mailing address

64 BAYBERRY RD
EWING NJ
08618-1028
US

V. Phone/Fax

Practice location:
  • Phone: 609-771-2387
  • Fax: 609-637-5101
Mailing address:
  • Phone: 609-771-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00000200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: