Dillon Douglass, DPT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

25MT00315800 Issued in NJ

Practice address

1925 Giants Dr
East Rutherford, NJ 07073-2140

Phone

(201) 935-8111

NPI assigned

Jun 12, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1013532357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SCHINDLER CT APT 166",
            "city": "EAST RUTHERFORD",
            "state": "NJ",
            "postal_code": "070732173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 GIANTS DR",
            "city": "EAST RUTHERFORD",
            "state": "NJ",
            "postal_code": "070732140",
            "telephone_number": "201-935-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "DILLON",
        "credential": "DPT,  ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-12",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NJ",
            "license": "25MT00315800",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02176600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• DGN Pharmacy, Inc
• Georgia M. Diakos, RN,PMHCNS-BC, APN, C
• Joseph William Dituro, M.D. N.D. B.C.I.M.
• Alev Dogan
• Joseph George Dooley, PT
• Drug Fair of East Rutherfod
• Dynamica Physical Therapy & Wellness LLC
• East Rutherford Board of Education
• East Rutherford Physical Therapy
• William Elbert, PTA

• Athletic Trainer in East Rutherford, NJ
• Providers in East Rutherford, NJ by specialty
• Athletic Trainer in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.