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General NPI Number Information
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NPI Number | 1255584702
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Entity Type | Individual
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Provider Name | LOVELL EDWIN EMERY JR. M.ED.,A.T.C
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 73 HAINES ST
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City | LANOKA HARBOR
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State | NJ
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Zip | 08734-2115
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Country | US
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Telephone | 609-242-4406
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Fax |
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Provider Business Mailing Address
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Address Line | 199 CHIPPEWA TRL
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City | MEDFORD LAKES
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State | NJ
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Zip | 08055-1813
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Country | US
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Telephone | 609-654-1437
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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 | 25MT00056600
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License Number State | NJ
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