Healthcare Provider Details

I. General information

NPI: 1578141735
Provider Name (Legal Business Name): DANIELLE SKIBA ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 2ND ST
HACKENSACK NJ
07601-5577
US

IV. Provider business mailing address

5 GRITMAN CT
WESTWOOD NJ
07675-3406
US

V. Phone/Fax

Practice location:
  • Phone: 201-646-7941
  • Fax:
Mailing address:
  • Phone: 201-681-8479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: