Individual
JONATHAN BOHORQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
314 FOREST DR, EDISON, NJ 08817-2719
(908) 930-6502
Mailing address
314 FOREST DR, EDISON, NJ 08817-2719
(908) 930-6502
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102016305
—
NJ
Enumeration date
06/04/2018
Last updated
06/04/2018
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