Healthcare Provider Details

I. General information

NPI: 1053470286
Provider Name (Legal Business Name): GEORGE D O'NEIL ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/20/2025
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 08/20/2025

III. Provider practice location address

PO BOX 71
PRINCETON NJ
08542-0071
US

IV. Provider business mailing address

2011 LEEDOMS DR
NEWTOWN PA
18940-9420
US

V. Phone/Fax

Practice location:
  • Phone: 609-258-3527
  • Fax: 609-258-7045
Mailing address:
  • Phone: 215-369-0502
  • Fax: 609-258-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00030500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: