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General NPI Number Information
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NPI Number | 1366960668
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Entity Type | Individual
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Provider Name | AUSTIN MEASE
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Gender | Male
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 91 S ORANGE AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4901
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Country | US
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Telephone | 316-807-5098
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Fax |
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Provider Business Mailing Address
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Address Line | 2 LINDA LN
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City | NEWTON
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State | NJ
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Zip | 07860-2717
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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 | 25MT00286500
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License Number State | NJ
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