Provider Demographics
NPI:1255584702
Name:EMERY, LOVELL EDWIN JR (MED,ATC)
Entity type:Individual
Prefix:MR
First Name:LOVELL
Middle Name:EDWIN
Last Name:EMERY
Suffix:JR
Gender:M
Credentials:MED,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 CHIPPEWA TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-1813
Mailing Address - Country:US
Mailing Address - Phone:609-654-1437
Mailing Address - Fax:
Practice Address - Street 1:73 HAINES ST
Practice Address - Street 2:
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734-2115
Practice Address - Country:US
Practice Address - Phone:609-242-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000566002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer