Provider Demographics
NPI:1164010617
Name:ALBANESE, MEGAN A (ATC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:A
Last Name:ALBANESE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34A ATHERTON CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3398
Mailing Address - Country:US
Mailing Address - Phone:201-650-9855
Mailing Address - Fax:
Practice Address - Street 1:67 HIGHLANDER DR
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1511
Practice Address - Country:US
Practice Address - Phone:201-650-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001875002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer