Individual
JONATHAN BENNEKE GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2360 MORRIS AVE, UNION, NJ 07083-5707
(678) 576-5141
Mailing address
130 OGDEN AVE # 2, JERSEY CITY, NJ 07307-1310
(678) 576-5141
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000030563
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
NJ
Other
Enumeration date
07/24/2017
Last updated
02/12/2018
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