Ivan Henriquez, ATC
Specialist/Technologist, Athletic Trainer in Secaucus, NJ. Individual provider (NPI-1).
NPI number1851001911
StatusActive
Last updated in NPPESDec 1, 2022
Details
- NPI
- 1851001911
- Entity type
- Individual (NPI-1)
- Name
- Mr. Ivan Henriquez
- Credential
- ATC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 30, 2022
- Certification date
- Dec 1, 2022
- Last updated
- Dec 1, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 2000052661 | NJ | Yes |
Practice location
55 Meadowlands PkwySecaucus, NJ 07094-2977
Phone 201-392-3424 · Fax 201-392-3056
Mailing address
8515 Bergenline Ave Apt 1aNorth Bergen, NJ 07047-5162
Phone 201-654-1513
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