Healthcare Provider Details

I. General information

NPI: 1750808846
Provider Name (Legal Business Name): TAYLOR PERRAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HILLSIDE AVE
FLANDERS NJ
07836
US

IV. Provider business mailing address

8 HILLSIDE AVE
FLANDERS NJ
07836-9045
US

V. Phone/Fax

Practice location:
  • Phone: 973-668-8489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003885-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00255700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: