Basic Information
| Provider Information | |||||||||
| NPI: | 1942951728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEGLIA | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 TRANQUILITY RD | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078214533 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 622 EAGLE ROCK AVE | ||||||||
| Address2: | |||||||||
| City: | WEST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070522994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736690078 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2022 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 25MT00218900 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.