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General NPI Number Information
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NPI Number | 1275289365
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Entity Type | Individual
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Provider Name | NICOLE ELIZABETH FALLON MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/27/2022
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 238 VAN BUREN ST
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City | NEWARK
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State | NJ
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Zip | 07105-2512
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Country | US
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Telephone | 732-640-3206
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Fax |
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Provider Business Mailing Address
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Address Line | 622 DRAKE AVE
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City | MIDDLESEX
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State | NJ
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Zip | 08846-2438
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Country | US
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Telephone | 732-640-3206
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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 | 25MT00319200
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License Number State | NJ
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