Healthcare Provider Details

I. General information

NPI: 1093625147
Provider Name (Legal Business Name): JOSH IBARRETA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GEORGIA RD
FREEHOLD NJ
07728-8034
US

IV. Provider business mailing address

30 GEORGIA RD
FREEHOLD NJ
07728-8034
US

V. Phone/Fax

Practice location:
  • Phone: 732-890-4101
  • Fax:
Mailing address:
  • Phone: 732-890-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: