Healthcare Provider Details

I. General information

NPI: 1679964167
Provider Name (Legal Business Name): JOSEPH MICHAEL SAVOIA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORMAL AVE
MONTCLAIR NJ
07043-1624
US

IV. Provider business mailing address

1 NORMAL AVE
MONTCLAIR NJ
07043-1624
US

V. Phone/Fax

Practice location:
  • Phone: 973-655-5250
  • Fax: 973-655-5436
Mailing address:
  • Phone: 973-655-5250
  • Fax: 973-655-5436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00117600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: