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NPI Code Detail

MEDICARE: ALYSSA BESLANOVITZ

MEDICARE:   ALYSSA  BESLANOVITZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer25MT00275100NJ

General Provider Information

NPI Number : 1184256943
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA BESLANOVITZ
Provider Business Mailing Address
First Line : 89 FRANKLIN AVE
Second Line :
City : HAZLET TOWNSHIP
State : NJ
Zip : 07734-3145
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 89 FRANKLIN AVE
Second Line :
City : HAZLET TOWNSHIP
State : NJ
Zip : 07734-3145
Country : US
Telephone Number : 732-546-7713
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2020
Last Update Date : 02/10/2020

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Directions to “ ALYSSA BESLANOVITZ ” Practice Location

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