Provider Demographics
NPI:1972605640
Name:D'AGOSTINO, JAROD MICHAEL (MS, ATC)
Entity Type:Individual
Prefix:
First Name:JAROD
Middle Name:MICHAEL
Last Name:D'AGOSTINO
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 VERNON AVE
Mailing Address - Street 2:APT 2K
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3656
Mailing Address - Country:US
Mailing Address - Phone:732-580-7526
Mailing Address - Fax:
Practice Address - Street 1:130 VERNON AVE
Practice Address - Street 2:APT 2K
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3656
Practice Address - Country:US
Practice Address - Phone:732-580-7526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer