Healthcare Provider Details

I. General information

NPI: 1255525283
Provider Name (Legal Business Name): KATHLEEN MARY DREYFUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2007
Last Update Date: 09/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 KRISTINA CT
MONROE TOWNSHIP NJ
08831-3750
US

IV. Provider business mailing address

8 KRISTINA CT
MONROE TOWNSHIP NJ
08831-3750
US

V. Phone/Fax

Practice location:
  • Phone: 908-337-6995
  • Fax:
Mailing address:
  • Phone: 908-337-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberQA04216
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: