Glen Depino, ATC
Individual provider Active NPI Athletic Trainer · Gladstone, NJ
NPI 1467577262 · NPPES record last updated Jul 26, 2010
Key facts
- NPI
- 1467577262
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 25MT00074500 (NJ)
- Practice address
- St . Bernard'S Rd
Gladstone, NJ 07934-0604 - Phone
- (908) 234-1611
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 25MT00074500 | NJ | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 25MT00074500 | NJ | Yes |
Addresses
Primary practice location
St . Bernard'S Rd
Gladstone, NJ 07934-0604
Mailing address
PO Box 604
St Bernard'S Rd
Gladstone, NJ 07934-0604
Other providers in Gladstone, NJ
- 2RNS, LLC
- Gulbir (Dina) K Anand
- Jill Brook
- Linda R Degaeta
- Donna Amundson LCSW
- Faith and Grace Psychothereapy
- Jeffrey Hammond
- Amy Soo Kemper
- Sarah Meinwieser
All providers in Gladstone, 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 Jul 26, 2010. 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.