Provider Demographics
NPI:1336417153
Name:EDMONDS, ROBERT (ATCL)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:ATCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WOODBRIDEG AVE. P.O. B
Mailing Address - Street 2:MIDDLESEX COUNTY COLLEGE
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08818
Mailing Address - Country:US
Mailing Address - Phone:732-548-6000
Mailing Address - Fax:
Practice Address - Street 1:2600 WOODBRIDGE AVE.
Practice Address - Street 2:MIDDLESEX COUNTY COLLEGE
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08818-3050
Practice Address - Country:US
Practice Address - Phone:732-548-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000110002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer