Individual
ABBEY RAIA FALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSED, ATC, LAT
Contact information
Practice address
619 WILDWOOD RD W, NORTHVALE, NJ 07647-1125
(201) 741-1460
Mailing address
619 WILDWOOD RD W, NORTHVALE, NJ 07647-1125
(201) 741-1460
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003139
NY
2255A2300X
Athletic Trainer
25MT0023100
NJ
Other
Enumeration date
10/12/2015
Last updated
11/07/2016
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