Provider Demographics
NPI:1801410493
Name:LORENZINI, DYLAN MATTHEW (ATC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:MATTHEW
Last Name:LORENZINI
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 1:748 DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2173
Mailing Address - Country:US
Mailing Address - Phone:609-805-4774
Mailing Address - Fax:
Practice Address - Street 1:748 DECATUR AVE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2173
Practice Address - Country:US
Practice Address - Phone:609-805-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002465002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer