Provider Demographics
NPI:1720488018
Name:KOROLEV, SAMUEL JACOB (MS, ATC/L)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JACOB
Last Name:KOROLEV
Suffix:
Gender:M
Credentials:MS, ATC/L
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:KOROLEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:631 S COLLEGE AVENUE
Mailing Address - Street 2:DFH ATHLETIC TRAINING ROOM
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19716-2010
Mailing Address - Country:US
Mailing Address - Phone:302-831-8857
Mailing Address - Fax:
Practice Address - Street 1:631 S COLLEGE AVENUE
Practice Address - Street 2:DFH ATHLETIC TRAINING ROOM
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716-2010
Practice Address - Country:US
Practice Address - Phone:302-831-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer