Active NPI
Jessica Taylor Dedomenico, MS,LAT, ATC
- Athletic Trainer
- Brick, NJ
National Provider Identifier
1457088700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 25MT00307100
- Practice address
- 110 Cartagena Dr
Brick, NJ 08723-7005 - Phone
- (609) 495-5899
- NPI assigned
- Aug 5, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 25MT00307100 | NJ | Primary |
Addresses
Primary practice location
110 Cartagena Dr
Brick, NJ 08723-7005
Mailing address
457 CR-64
Brick, NJ 08724
Phone (732) 800-9000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MT00307100 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659657600000",
"number": "1457088700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "457 CR-64",
"city": "BRICK",
"state": "NJ",
"postal_code": "08724",
"telephone_number": "732-800-9000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 CARTAGENA DR",
"city": "BRICK",
"state": "NJ",
"postal_code": "087237005",
"telephone_number": "609-495-5899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDOMENICO",
"first_name": "JESSICA",
"middle_name": "TAYLOR",
"credential": "MS,LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-05",
"last_updated": "2022-08-05",
"certification_date": "2022-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "25MT00307100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.