Kristen Ann Mandicz, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

41 Jackson Valley Rd
Washington, NJ 07882-1037

Phone

(908) 892-1952

NPI assigned

Mar 18, 2020

Sex

Female

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

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584489600000",
    "number": "1760018006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 CANAL WAY",
            "city": "HACKETTSTOWN",
            "state": "NJ",
            "postal_code": "078401266",
            "telephone_number": "908-892-1952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 JACKSON VALLEY RD",
            "city": "WASHINGTON",
            "state": "NJ",
            "postal_code": "078821037",
            "telephone_number": "908-892-1952"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "119 Canal Way",
            "address_purpose": "LOCATION",
            "city": "Hackettstown",
            "state": "NJ",
            "postal_code": "078401266",
            "country_code": "US",
            "telephone_number": "908-892-1952",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANDICZ",
        "first_name": "KRISTEN",
        "middle_name": "ANN",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-18",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Leigh Lovenberg, LSW
• Patrick C Mack, D.C.
• Brooke Mahalick, LCSW
• Barbara L Maloney
• Laura L Mandaglio, L. P. T.
• Joelle Manganella, PT, DPT
• Matthew J Mansey, D.D.S.
• Carlee Marcinkowski, LPC
• Ian Martinez, M.D.
• Amanda L Matlee, MSW LSW

• Athletic Trainer in Washington, NJ
• Providers in Washington, NJ by specialty
• Athletic Trainer in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; 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.