Individual
JUSTIN DEREK HARBST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
90 E SHORE RD, GREAT NECK, NY 11023-2409
(516) 684-1122
Mailing address
2557 14TH ST APT 1, ASTORIA, NY 11102-3720
(607) 821-8421
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002123
NY
Other
Enumeration date
10/31/2012
Last updated
10/31/2012
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