Daniel Deshong, ATC

Key facts

NPI

1558777904

Entity type

Individual (NPI type 1)

Primary specialty

Athletic Trainer 2255A2300X

License

25MT00197800 (NJ)

Practice address

613 Park Ave
Port Monmouth, NJ 07758-1616

Phone

(201) 401-7311

NPI assigned

Jul 7, 2014

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 7, 2014.

{
    "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.
• Brianne Dwyer, RBT
• Eckerd Corporation
• Jay Hochheiser, L.C.S.W.

All providers in Port Monmouth, NJ · Athletic Trainer in New Jersey