MEDICARE: MR. JUSTIN FOSTER I

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
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1265982813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN FOSTER I

Provider Business Mailing Address
First Line	:	1424 MARLBOROUGH AVE
Second Line	:
City	:	PLAINFIELD
State	:	NJ
Zip	:	07060-3315
Country	:	US
Telephone Number	:	908-546-0573
Fax Number	:

Provider Business Practice Location Address
First Line	:	1424 MARLBOROUGH AVE
Second Line	:
City	:	PLAINFIELD
State	:	NJ
Zip	:	07060-3315
Country	:	US
Telephone Number	:	908-546-0573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	10/07/2016

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