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General NPI Number Information
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NPI Number | 1568084705
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Entity Type | Individual
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Provider Name | FRANCIS PATRICK REARDON
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Gender | Male
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 1033 SPRINGFIELD AVE
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City | CRANFORD
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State | NJ
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Zip | 07016-1598
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Country | US
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Telephone | 732-693-3629
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Fax |
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Provider Business Mailing Address
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Address Line | 293 SANDY HOOK AVE
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City | BELFORD
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State | NJ
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Zip | 07718-1254
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Country | US
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Telephone | 732-693-3629
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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 | 25MT00251600
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License Number State | NJ
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