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General NPI Number Information
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NPI Number | 1982341608
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Entity Type | Individual
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Provider Name | JAIME KANTOR
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Gender | Female
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Dates
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Enumeration Date | 05/14/2022
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Last Update Date | 05/14/2022
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Provider Practice Location Address
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Address Line | 715 TODT HILL RD
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1312
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Country | US
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Telephone | 718-303-7859
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Fax |
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Provider Business Mailing Address
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Address Line | 21 FRASER ST
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6111
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Country | US
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Telephone | 917-750-3155
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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 | 003116
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License Number State | NY
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