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General NPI Number Information
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NPI Number | 1255992970
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Entity Type | Individual
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Provider Name | STEVEN R PAPA LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 225 W GRAND AVE
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City | MONTVALE
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State | NJ
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Zip | 07645-1757
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Country | US
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Telephone | 201-358-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 826 3RD ST
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City | SECAUCUS
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State | NJ
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Zip | 07094-3412
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Country | US
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Telephone | 201-210-2553
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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 | 25MT00084400
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License Number State | NJ
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