Provider Demographics
NPI:1497950604
Name:FRANOLICH, DAMIEN JOSEPH (ATC)
Entity Type:Individual
Prefix:MR
First Name:DAMIEN
Middle Name:JOSEPH
Last Name:FRANOLICH
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 1:309 MAIN ST
Mailing Address - Street 2:APT 13
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-5211
Mailing Address - Country:US
Mailing Address - Phone:845-729-8534
Mailing Address - Fax:
Practice Address - Street 1:295 IVY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3501
Practice Address - Country:US
Practice Address - Phone:845-729-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001191002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer