Abbey Raia Fallon, BSED, ATC, LAT
Individual provider Active NPI Athletic Trainer · Northvale, NJ
NPI 1124499561 · NPPES record last updated Nov 7, 2016
Key facts
- NPI
- 1124499561
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 003139 (NY)
- Practice address
- 619 Wildwood Rd W
Northvale, NJ 07647-1125 - Phone
- (201) 741-1460
- NPI assigned
- Oct 12, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MT0023100 | NJ | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 003139 | NY | Yes |
| Athletic Trainer | 2255A2300X | 25MT0023100 | NJ |
Addresses
Primary practice location
619 Wildwood Rd W
Northvale, NJ 07647-1125
Mailing address
619 Wildwood Rd W
Northvale, NJ 07647-1125
Phone (201) 741-1460
Other providers in Northvale, NJ
- Leonard Digiovanni
- Thomas Matthew Donofrio
- Dynamic Physical Therapy and Sports Rehabilitations
- Dynamic Physical Therapy at Home
- Epher Serrano Espinola
- Henry Scott Farah
- First Med Family Health Care LLC
- Firstmed Family Healthcare LLC
- William Edward Fisher
- Jody Maureen Flynn X
All providers in Northvale, NJ · Athletic Trainer in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.