Provider Demographics
NPI:1033244629
Name:LAMENDELLA, PENELOPE A (PT)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:A
Last Name:LAMENDELLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:PENELOPE
Other - Middle Name:A
Other - Last Name:STEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:85 LECLERC AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-638-8039
Mailing Address - Fax:
Practice Address - Street 1:200 SHEARWATER COURT WEST
Practice Address - Street 2:UNIT #34
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305
Practice Address - Country:US
Practice Address - Phone:201-638-8039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00922500174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00435905OtherRAILROAD MEDICARE
NJP00435905OtherRAILROAD MEDICARE
NJ053717S5YMedicare PIN