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1346046059 NPI number — DAMIEN JERMAINE GROOMS

NPI Number: 1346046059
Health Care Provider/Practitioner: DAMIEN JERMAINE GROOMS

Information about “1346046059” NPI (DAMIEN JERMAINE GROOMS) exists in 1346046059 in HTML format HTML  |  1346046059 in plain Text format TXT  |  1346046059 in PDF (Portable Document Format) PDF  |  1346046059 in an XML format XML  formats.

NPI Number : 1346046059 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346046059",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GROOMS",
    "FirstName": "DAMIEN",
    "MiddleName": "JERMAINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "509 GOULDTOWN WOODRUFF RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRIDGETON",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08302-7244",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "856-776-1403",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "201 MULLICA HILL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLASSBORO",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08028-1702",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "856-256-4000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/22/2025",
    "LastUpdateDate": "02/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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