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General NPI Number Information
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NPI Number | 1457487225
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Entity Type | Individual
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Provider Name | MARK A DONETZ ATC
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 90 PARKER ST BARRINGER HIGH SCHOOL
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City | NEWARK
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State | NJ
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Zip | 07104-1028
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Country | US
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Telephone | 973-733-0069
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Fax |
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Provider Business Mailing Address
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Address Line | 119 WASHINGTON AVE
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City | MAYWOOD
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State | NJ
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Zip | 07607-2038
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Country | US
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Telephone | 201-226-9810
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Fax | 201-226-9810
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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 | 25MT00069700
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License Number State | NJ
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