Healthcare Provider Details

I. General information

NPI: 1720126014
Provider Name (Legal Business Name): MARINA LEHMAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MAIN ST
HACKENSACK NJ
07601-5914
US

IV. Provider business mailing address

605 MAIN ST
HACKENSACK NJ
07601-5914
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-0488
  • Fax:
Mailing address:
  • Phone: 201-488-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01627500
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier18808
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerPT LICENCE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: