Healthcare Provider Details

I. General information

NPI: 1659116325
Provider Name (Legal Business Name): LENA IDRISSI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 130 N
BURLINGTON COUNTY NJ
08075
US

IV. Provider business mailing address

1 FOX HOLLOW RD
VOORHEES NJ
08043-2923
US

V. Phone/Fax

Practice location:
  • Phone: 856-461-8331
  • Fax:
Mailing address:
  • Phone: 267-560-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02259300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: