MEDICARE: MARQUISE PEEL ATC

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	:	1538878392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUISE PEEL ATC

Provider Business Mailing Address
First Line	:	118 W 3RD ST APT 3
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002-2307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2641 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5943
Country	:	US
Telephone Number	:	888-772-9933
Fax Number	:

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

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	11/21/2022

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Directions to “ MARQUISE PEEL ATC” Practice Location

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