Raymond N. Divirgilio
Specialist/Technologist, Athletic Trainer in Union, NJ. Individual provider (NPI-1).
NPI number1003323908
StatusActive
Last updated in NPPESJan 2, 2018
Details
- NPI
- 1003323908
- Entity type
- Individual (NPI-1)
- Name
- Raymond N. Divirgilio
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 2, 2018
- Last updated
- Jan 2, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 25MT00031600 | NJ | Yes |
Practice location
1000 Morris AveUnion, NJ 07083-7133
Phone 908-737-0663
Mailing address
119 Glenwood RdFanwood, NJ 07023-1474
Phone 908-737-0663
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