Individual
JUSTIN HENRY CORCORAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSA, ATC, LAT
Contact information
Practice address
68 RIVER RD, SUMMIT, NJ 07901-1450
(201) 277-0800
Mailing address
10 LAYTON RD APT 57, WANTAGE, NJ 07461-1805
(973) 459-2319
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
002266-1
NY
2255A2300X
Athletic Trainer
Primary
25MT00178900
NJ
Other
Enumeration date
11/11/2014
Last updated
11/11/2014
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