Provider Demographics
NPI:1235262262
Name:KILMER, GREGORY R (ATC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:R
Last Name:KILMER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 MAIN ST
Mailing Address - Street 2:APT B-1
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1169
Mailing Address - Country:US
Mailing Address - Phone:973-218-0175
Mailing Address - Fax:
Practice Address - Street 1:34 WILSON AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-4075
Practice Address - Country:US
Practice Address - Phone:908-769-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer