Provider Demographics
NPI:1316569866
Name:TREMBLAY, MICHAEL JAMISON (MS, ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMISON
Last Name:TREMBLAY
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28108 CHERRY BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1287
Mailing Address - Country:US
Mailing Address - Phone:774-644-9768
Mailing Address - Fax:
Practice Address - Street 1:CALDWELL FIELDHOUSE PRINCETON UNIVERSITY CAMPUS
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08544-0001
Practice Address - Country:US
Practice Address - Phone:609-258-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002706002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer