Individual
MR. JUSTIN RAYMOND MCCONVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(917) 617-8668
Mailing address
3201 TIERNEY PL, BRONX, NY 10465-4023
(917) 617-8668
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
004490
NY
Other
Enumeration date
03/09/2023
Last updated
03/09/2023
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