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General NPI Number Information
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NPI Number | 1508903055
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Entity Type | Individual
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Provider Name | JESSICA JANE KIPNES ATC
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 1345 EASTON AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-1412
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Country | US
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Telephone | 732-545-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 975A BERGEN AVE
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-2334
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Country | US
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Telephone | 802-522-4648
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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 | 25MT00172600
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License Number State | NJ
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