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General NPI Number Information
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NPI Number | 1932486552
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Entity Type | Individual
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Provider Name | CRISTA ANN SCIANCALEPORE ATC
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Gender | Female
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 400 S ORANGE AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2646
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Country | US
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Telephone | 973-761-9499
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CRANFORD TER
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City | CRANFORD
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State | NJ
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Zip | 07016-3407
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Country | US
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Telephone | 908-917-3780
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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 | 25MT00147400
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License Number State | NJ
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