Provider Demographics
NPI:1023136553
Name:CARNEY, VANESSA A (ATC, MAT)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:A
Last Name:CARNEY
Suffix:
Gender:F
Credentials:ATC, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 GROSS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2033
Mailing Address - Country:US
Mailing Address - Phone:732-525-9390
Mailing Address - Fax:
Practice Address - Street 1:17 PARKER AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1327
Practice Address - Country:US
Practice Address - Phone:973-762-5600
Practice Address - Fax:973-378-7607
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000404002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer