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General NPI Number Information
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NPI Number | 1447803200
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Entity Type | Individual
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Provider Name | RAUL MARQUES FERREIRA
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Gender | Male
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 577 GOFFLE RD
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City | WYCKOFF
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State | NJ
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Zip | 07481-2946
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Country | US
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Telephone | 201-857-5910
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Fax | 201-857-5911
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Provider Business Mailing Address
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Address Line | 18 OAK ST
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City | RIDGEFIELD PARK
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State | NJ
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Zip | 07660-2217
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Country | US
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Telephone | 201-951-3539
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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 | 25MT00267000
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License Number State | NJ
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