Individual
SIMON RODRIGUEZLOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 JETS DR, FLORHAM PARK, NJ 07932-1215
(973) 549-4706
Mailing address
60 MAITLAND AVE, PATERSON, NJ 07502-2034
(973) 405-7922
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00244500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25T00244500
ATHLETIC TRAINER
NJ
Enumeration date
09/19/2017
Last updated
09/19/2017
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