Provider Demographics
NPI:1922544378
Name:GARY, JOHN (ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GARY
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 1:106 S PACKARD ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1612
Mailing Address - Country:US
Mailing Address - Phone:609-412-4727
Mailing Address - Fax:
Practice Address - Street 1:16 E 52ND ST
Practice Address - Street 2:6TH FLLOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5306
Practice Address - Country:US
Practice Address - Phone:212-752-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0025922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer