Provider Demographics
NPI:1447965629
Name:NEW, TONY GERALD III
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:GERALD
Last Name:NEW
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 JAMES HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8486
Mailing Address - Country:US
Mailing Address - Phone:980-425-1475
Mailing Address - Fax:
Practice Address - Street 1:2614 JAMES HAMILTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-8486
Practice Address - Country:US
Practice Address - Phone:980-425-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer