MEDICARE: JOHN KING

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	:	1538095823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KING

Provider Business Mailing Address
First Line	:	2050 JONES AVE
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-3818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 JONES AVE
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-3818
Country	:	US
Telephone Number	:	516-666-2691
Fax Number	:

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

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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