Individual
MS. KELSEY LYN PENGITORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATHLETIC TRAINER
Contact information
Practice address
111 MADISON AVE STE 110, MORRISTOWN, NJ 07960-6083
(862) 260-7174
Mailing address
31 HUDSON PL APT 2, BLOOMFIELD, NJ 07003-4010
(973) 997-9158
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00188800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MT00188800
LICENSE NUMBER
—
Enumeration date
10/14/2020
Last updated
10/14/2020
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