Justin Derek Harbst, ATC
Specialist/Technologist, Athletic Trainer in Great Neck, NY. Individual provider (NPI-1).
NPI number1497009369
StatusActive
Last updated in NPPESOct 31, 2012
Details
- NPI
- 1497009369
- Entity type
- Individual (NPI-1)
- Name
- Justin Derek Harbst
- Credential
- ATC
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 31, 2012
- Last updated
- Oct 31, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 002123 | NY | Yes |
Practice location
90 E Shore RdGreat Neck, NY 11023-2409
Phone 516-684-1122
Mailing address
2557 14th St Apt 1Astoria, NY 11102-3720
Phone 607-821-8421
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