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General NPI Number Information
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NPI Number | 1760376701
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Entity Type | Individual
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Provider Name | JULIA ROSE DUARDO ATC
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Gender | Female
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 120 VALLEY RD STE 100
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2321
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Country | US
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Telephone | 201-490-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 22 N 5TH ST
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City | PARK RIDGE
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State | NJ
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Zip | 07656-1641
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Country | US
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Telephone | 201-306-2556
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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 | 25MT00340900
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License Number State | NJ
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