Provider Demographics
NPI:1598985087
Name:SNYDER, JILL P (ATC CERTIFIED ATHLET)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:P
Last Name:SNYDER
Suffix:
Gender:F
Credentials:ATC CERTIFIED ATHLET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HARDSCRABBLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510
Mailing Address - Country:US
Mailing Address - Phone:973-271-2520
Mailing Address - Fax:
Practice Address - Street 1:44 LAKESIDE AVE
Practice Address - Street 2:POMPTON LAKES HIGH SCHOOL
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442
Practice Address - Country:US
Practice Address - Phone:973-835-7100
Practice Address - Fax:973-835-1054
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000041002255A2300X
VT10400000712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer