Active NPI
Ivan Henriquez, ATC
- Athletic Trainer
- Secaucus, NJ
National Provider Identifier
1851001911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000052661
- Practice address
- 55 Meadowlands Pkwy
Secaucus, NJ 07094-2977 - Phone
- (201) 392-3424
- Fax
- (201) 392-3056
- NPI assigned
- Nov 30, 2022
- Last updated
- Dec 1, 2022
- Sex
- Male
- Sole proprietor
- No
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 | 2000052661 | NJ | Primary |
Addresses
Primary practice location
55 Meadowlands Pkwy
Secaucus, NJ 07094-2977
Mailing address
8515 Bergenline Ave Apt 1a
North Bergen, NJ 07047-5162
Phone (201) 654-1513
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 |
|---|---|---|---|
| 2000052661 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669852800000",
"number": "1851001911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8515 BERGENLINE AVE APT 1A",
"city": "NORTH BERGEN",
"state": "NJ",
"postal_code": "070475162",
"telephone_number": "201-654-1513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 MEADOWLANDS PKWY",
"city": "SECAUCUS",
"state": "NJ",
"postal_code": "070942977",
"telephone_number": "201-392-3424",
"fax_number": "201-392-3056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRIQUEZ",
"first_name": "IVAN",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-30",
"last_updated": "2022-12-01",
"certification_date": "2022-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "2000052661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Secaucus, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.