Provider Demographics
NPI:1528221389
Name:PADRON, DOUG (ATC)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:PADRON
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 1:400 CEDAR AVENUE
Mailing Address - Street 2:MONMOUTH UNIVERSITY
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1898
Mailing Address - Country:US
Mailing Address - Phone:732-571-3672
Mailing Address - Fax:732-263-5265
Practice Address - Street 1:400 CEDAR AVENUE
Practice Address - Street 2:MONMOUTH UNIVERSITY
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1898
Practice Address - Country:US
Practice Address - Phone:732-571-3672
Practice Address - Fax:732-263-5265
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0897025812255A2300X
NJ089702381390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089702581OtherCERTIFICATION NUMBER