Healthcare Provider Details

I. General information

NPI: 1376505727
Provider Name (Legal Business Name): JOANNE M PLOCH ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 11/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 COUNTY ROUTE 565
VERNON NJ
07462
US

IV. Provider business mailing address

1832 COUNTY ROUTE 565 PO BOX 800
VERNON NJ
07462
US

V. Phone/Fax

Practice location:
  • Phone: 973-764-2995
  • Fax:
Mailing address:
  • Phone: 973-764-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00038500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: