Healthcare Provider Details

I. General information

NPI: 1265799050
Provider Name (Legal Business Name): LINDSAY ANN REQUA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GROVE ST
HADDON HEIGHTS NJ
08035-1761
US

IV. Provider business mailing address

401 ROUTE 73 N BLDG 10
MARLTON NJ
08053-3425
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-3746
  • Fax: 877-446-4094
Mailing address:
  • Phone: 856-872-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB09948500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS017561
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: