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General NPI Number Information
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NPI Number | 1831680818
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Entity Type | Individual
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Provider Name | MAIKEE BERNADETTE MIGALLOS ATC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 400 CEDAR AVE
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1804
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Country | US
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Telephone | 732-263-4473
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Fax |
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Provider Business Mailing Address
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Address Line | 400 NORWOOD AVE
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1828
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Country | US
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Telephone | 973-866-6663
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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 | 25MT00214400
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License Number State | NJ
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