Provider Demographics
NPI:1033381843
Name:SHENOUDA, SAFWAT RAGHEB (PT)
Entity Type:Individual
Prefix:
First Name:SAFWAT
Middle Name:RAGHEB
Last Name:SHENOUDA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 FOREST GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2414
Mailing Address - Country:US
Mailing Address - Phone:201-281-6137
Mailing Address - Fax:
Practice Address - Street 1:202 FOREST GLEN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-2414
Practice Address - Country:US
Practice Address - Phone:201-281-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01030300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty