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General NPI Number Information
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NPI Number | 1497950604
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Entity Type | Individual
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Provider Name | DAMIEN JOSEPH FRANOLICH ATC
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Gender | Male
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/03/2009
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Provider Practice Location Address
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Address Line | 295 IVY ST 2ND FLOOR
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City | KEARNY
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State | NJ
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Zip | 07032-3501
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Country | US
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Telephone | 845-729-8534
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Fax |
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Provider Business Mailing Address
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Address Line | 309 MAIN ST APT 13
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City | BELLEVILLE
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State | NJ
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Zip | 07109-5211
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Country | US
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Telephone | 845-729-8534
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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 | 25MT00119100
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License Number State | NJ
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