Provider Demographics
NPI:1336256080
Name:ROYER, SCOTT VINCENT (MA, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:VINCENT
Last Name:ROYER
Suffix:
Gender:M
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAVALLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:08735-2404
Mailing Address - Country:US
Mailing Address - Phone:201-697-5295
Mailing Address - Fax:
Practice Address - Street 1:101 DON CONNOR BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3407
Practice Address - Country:US
Practice Address - Phone:732-833-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001134002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer