Individual
TRAVIS LAMONT HENDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9 HOSPITAL DR STE B4, TOMS RIVER, NJ 08755-6425
(732) 905-6635
(732) 905-6643
Mailing address
86 FAIRWAY CT APT L, LAKEWOOD, NJ 08701-7255
(305) 951-5523
(587) 487-6166
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
25MB10117100
NJ
390200000X
Student in an Organized Health Care Education/Training Program
OT014442
PA
Other
Enumeration date
04/20/2012
Last updated
09/17/2020
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