Healthcare Provider Details

I. General information

NPI: 1700803350
Provider Name (Legal Business Name): LAUREN JOY MCALISTER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MONROE AVE
KENILWORTH NJ
07033-1220
US

IV. Provider business mailing address

202 WESTCHESTER CT UNIT # 2
UNION NJ
07083-8756
US

V. Phone/Fax

Practice location:
  • Phone: 908-931-9696
  • Fax:
Mailing address:
  • Phone: 609-385-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00130200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: