Individual
MICHAEL R DESOCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
112 BROAD ST, RED BANK, NJ 07701-1915
(732) 921-6692
Mailing address
11 CIRCLE LN, LITTLE SILVER, NJ 07739-1116
(732) 977-9610
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00151100
NJ
2255A2300X
Athletic Trainer
RT004347
PA
Other
Enumeration date
04/13/2009
Last updated
04/13/2009
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