Individual
MR. IVAN HENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
55 MEADOWLANDS PKWY, SECAUCUS, NJ 07094-2977
(201) 392-3424
(201) 392-3056
Mailing address
8515 BERGENLINE AVE APT 1A, NORTH BERGEN, NJ 07047-5162
(201) 654-1513
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000052661
NJ
Other
Enumeration date
11/30/2022
Last updated
12/01/2022
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