Healthcare Provider Details

I. General information

NPI: 1023989001
Provider Name (Legal Business Name): MICHAEL JAMES RAMUNDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MADISON AVE
MADISON NJ
07940-1434
US

IV. Provider business mailing address

5 PARSONS RD
LINCOLN PARK NJ
07035-1213
US

V. Phone/Fax

Practice location:
  • Phone: 973-408-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00343100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: