Provider Demographics
NPI:1669975199
Name:BELL, HILLARY (ATC, LAT)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BLOOMFIELD AVE APT C4
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2021
Mailing Address - Country:US
Mailing Address - Phone:802-999-8840
Mailing Address - Fax:
Practice Address - Street 1:411 BLOOMFIELD AVE APT C4
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2021
Practice Address - Country:US
Practice Address - Phone:802-999-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000176862255A2300X
NJ25MT002304002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000017686OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER
NJ25MT00230400OtherNEW JERSEY DIVISION OF CONSUMER AFFAIRS: STATE BOARD OF MEDICAL EXAMINERS