Khalif Dubose, MS LAT ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

25MT00303800 Issued in NJ

Practice address

1133 Livingston Ave Apt 9
North Brunswick, NJ 08902-3807

Phone

(732) 470-7309

NPI assigned

Mar 16, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1647388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1194473363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 LIVINGSTON AVE APT 9",
            "city": "NORTH BRUNSWICK",
            "state": "NJ",
            "postal_code": "089023807",
            "telephone_number": "732-470-7309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 LIVINGSTON AVE APT 9",
            "city": "NORTH BRUNSWICK",
            "state": "NJ",
            "postal_code": "089023807",
            "telephone_number": "732-470-7309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBOSE",
        "first_name": "KHALIF",
        "credential": "MS LAT ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-16",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NJ",
            "license": "25MT00303800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen M. Drummond, BCBA
• Yong Du, DPT
• Sonam Dubal
• Brian Charles Dubin, DMD
• Joseph Rand Dubin, DDS
• Dungarvin New Jersey, LLC - Somerset Day Program
• Dungarvin New Jersey, LLC-Albury
• Dungarvin New Jersey, LLC-Antonio
• Michael Dutko
• Jeffrey V Dyke

• Athletic Trainer in North Brunswick, NJ
• Providers in North Brunswick, 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 Mar 16, 2022; 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.