MEDICARE: COLE MULHOLLAND

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		NJ

General Provider Information

NPI Number	:	1821686015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLE MULHOLLAND

Provider Business Mailing Address
First Line	:	33 CHESTNUT AVE
Second Line	:
City	:	POMPTON LAKES
State	:	NJ
Zip	:	07442-2446
Country	:	US
Telephone Number	:	862-228-2192
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 CHESTNUT AVE
Second Line	:
City	:	POMPTON LAKES
State	:	NJ
Zip	:	07442-2446
Country	:	US
Telephone Number	:	862-228-2192
Fax Number	:

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

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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Directions to “ COLE MULHOLLAND ” Practice Location

Language	Start Address	Practice Location

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