Active NPI
Daniel Deshong, ATC
- Athletic Trainer
- Port Monmouth, NJ
National Provider Identifier
1558777904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 25MT00197800
- Practice address
- 613 Park Ave
Port Monmouth, NJ 07758-1616 - Phone
- (201) 401-7311
- NPI assigned
- Jul 7, 2014
- Last updated
- Jul 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 | 25MT00197800 | NJ | Primary |
Addresses
Primary practice location
613 Park Ave
Port Monmouth, NJ 07758-1616
Mailing address
613 Park Ave
Port Monmouth, NJ 07758-1616
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MT00197800 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404691200000",
"number": "1558777904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "613 PARK AVE",
"city": "PORT MONMOUTH",
"state": "NJ",
"postal_code": "077581616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "613 PARK AVE",
"city": "PORT MONMOUTH",
"state": "NJ",
"postal_code": "077581616",
"telephone_number": "201-401-7311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESHONG",
"first_name": "DANIEL",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-07",
"last_updated": "2014-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "25MT00197800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Monmouth, NJ
- Christine Andreotti Bennett, L.P.C.
- Leeann Rose Bennett
- George Richard Bulger, DROT, OTR/L
- Center for Family Support, New Jersey, Inc.
- Community Options, Inc.
- Craig Domanski, M.A., BCBA
- Drug Fair Group, Inc. (Drug Fair of Port Monmouth 48)
- Brianne Dwyer, RBT
- Eckerd Corporation (Rite Aid Pharmacy 10425)
- Jay Hochheiser, L.C.S.W.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.