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General NPI Number Information
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NPI Number | 1710807185
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Entity Type | Individual
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Provider Name | JACQUELINE M PANICO
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Gender |
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 2083 LAWRENCEVILLE RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-3099
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Country | US
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Telephone | 856-278-7794
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Fax |
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Provider Business Mailing Address
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Address Line | 224 EDGEWOOD AVE
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City | AUDUBON
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State | NJ
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Zip | 08106-2225
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Country | US
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Telephone | 856-278-7794
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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 | 25MT00346900
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License Number State | NJ
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