Kemoy Davidson, LAT, ATC, NREMT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

25MT00283300 Issued in NJ

Practice address

300 Pompton Rd
Wayne, NJ 07470-2103

Phone

(973) 720-2000

NPI assigned

Feb 9, 2021

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": "1612828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614384000000",
    "number": "1528650751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 E TRYON AVE APT 16",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076666154",
            "telephone_number": "201-530-5064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 POMPTON RD",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702103",
            "telephone_number": "973-720-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "KEMOY",
        "credential": "LAT, ATC, NREMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-02-27",
        "certification_date": "2021-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "NJ",
            "license": "641258",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NJ",
            "license": "25MT00283300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brynn Colleen Darpino, OTR/L
• Farhad Daruwala
• Dhirendra Nath Das, M.D., F.A.C.C., FACP
• Steven David, M.D.
• Bernard Davidson, RPH
• Dayspring & Macaluso MD'S
• Jeffrey Thomas De Bellis, PT, MS, OCS
• Angelina Elizabeth De la Osa, RD
• Deanna Z. Macek, MD, LLC
• Debra L. Rosenzweig, M.D.

• All providers in Wayne, NJ
• Athletic Trainer in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2021; 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.