Active NPI
Jacqueline Cividanes, ATC
- Athletic Trainer
- Bloomfield, NJ
National Provider Identifier
1922408293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 25MT00192200
- Practice address
- 467 Franklin St
Athletics Department
Bloomfield, NJ 07003-3425 - Phone
- (973) 748-9000
- NPI assigned
- Aug 24, 2014
- Sex
- Female
- 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 | 25MT00192200 | NJ | Primary |
Addresses
Primary practice location
467 Franklin St
Athletics Department
Bloomfield, NJ 07003-3425
Mailing address
467 Franklin St
Athletics Department
Bloomfield, NJ 07003-3425
Phone (973) 748-9000
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 |
|---|---|---|---|
| 25MT00192200 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408838400000",
"number": "1922408293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "467 FRANKLIN ST",
"address_2": "ATHLETICS DEPARTMENT",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070033425",
"telephone_number": "973-748-9000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "467 FRANKLIN ST",
"address_2": "ATHLETICS DEPARTMENT",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070033425",
"telephone_number": "973-748-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CIVIDANES",
"first_name": "JACQUELINE",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-24",
"last_updated": "2014-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "25MT00192200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.