Healthcare Provider Details

I. General information

NPI: 1184735128
Provider Name (Legal Business Name): DEBORAH JEAN ANKELEIN B.A.,M.S., ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 BROWN AVE
PROSPECT PARK NJ
07508-2018
US

IV. Provider business mailing address

11 MAINES LN
HARDWICK NJ
07825-9617
US

V. Phone/Fax

Practice location:
  • Phone: 973-790-7909
  • Fax: 973-790-3536
Mailing address:
  • Phone: 201-281-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00075100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: