=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174073407
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER BOVE MS, LAT, ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2016
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 GUNN RD
-----------------------------------------------------
City | BRANCHVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07826-4166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-534-4017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 GUNN RD
-----------------------------------------------------
City | BRANCHVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07826-4166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-534-4017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 25MT00253100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | RT006824
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------