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General NPI Number Information
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NPI Number | 1215453923
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Entity Type | Individual
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Provider Name | MICHAEL T REGAN ATC, EMT-B
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Gender | Male
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 478 ELWOOD RD
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City | ELWOOD
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State | NY
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Zip | 11731-4828
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Country | US
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Telephone | 978-382-2859
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Fax |
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Provider Business Mailing Address
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Address Line | 6109 171ST ST FL 2
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-2023
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Country | US
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Telephone |
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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 | 003189
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License Number State | NY
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