Ivan Candelaria, ATC, L, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0008521 Issued in NY

Practice address

32 Lamberts Lane
Staten Island, NY 10314

Phone

(718) 477-7883

NPI assigned

Jul 5, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188259200000",
    "number": "1710918214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 LAMBERTS LN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103147207",
            "telephone_number": "917-846-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 LAMBERTS LANE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10314",
            "telephone_number": "718-477-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANDELARIA",
        "first_name": "IVAN",
        "name_prefix": "Mr.",
        "credential": "ATC, L, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "0008521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean Canavan, R.N.
• Amanda Cancel
• Marlon Vincent Dabu Cancio, OT
• Maryrosebeverly Gonzales Cancio, OTA
• John Robert Candela
• Jingle Candelasa
• Kristofer Candella, D.O.
• Angela Cangemi
• Lucille Cangialosi, D.D.S.
• Megan Ann Cangro

• Athletic Trainer in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; 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.