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General NPI Number Information
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NPI Number | 1174390736
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Entity Type | Individual
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Provider Name | MATTHEW MICHAEL JUNIO MS, LAT. ATC
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Gender | Male
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 218 MOUNTAIN WAY
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City | LYNDURST
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State | NJ
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Zip | 07071-1614
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Country | US
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Telephone | 551-587-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 2 MADALINE DR
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City | EDISON
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State | NJ
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Zip | 08820-1127
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Country | US
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Telephone | 908-769-8326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT007427
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00266300
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License Number State | NJ
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