Healthcare Provider Details

I. General information

NPI: 1073850996
Provider Name (Legal Business Name): LISA CURTIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PROSPECT AVE
HACKENSACK NJ
07601-1960
US

IV. Provider business mailing address

2142 UTOPIA PKWY
WHITESTONE NY
11357-4142
US

V. Phone/Fax

Practice location:
  • Phone: 201-403-4528
  • Fax: 201-225-9223
Mailing address:
  • Phone: 718-767-0610
  • Fax: 516-750-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00802100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: