=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437540598
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN ROBERT SINGLEY ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2015
-----------------------------------------------------
Last Update Date | 02/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 BRACKEN RD
-----------------------------------------------------
City | WEST MILFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07480-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-934-7309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 BRACKEN RD
-----------------------------------------------------
City | WEST MILFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07480-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-934-7309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 25MT00184600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------