Healthcare Provider Details

I. General information

NPI: 1992667638
Provider Name (Legal Business Name): LEA FRUCHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 LAFAYETTE BLVD
LAKEWOOD NJ
08701-2956
US

IV. Provider business mailing address

184 LAFAYETTE BLVD
LAKEWOOD NJ
08701-2956
US

V. Phone/Fax

Practice location:
  • Phone: 732-523-1655
  • Fax:
Mailing address:
  • Phone: 732-523-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01093600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: