Provider Demographics
NPI:1174195747
Name:LANE, JENYCE (ATC)
Entity Type:Individual
Prefix:
First Name:JENYCE
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5140
Mailing Address - Country:US
Mailing Address - Phone:732-266-1564
Mailing Address - Fax:
Practice Address - Street 1:1030 DELTA BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-1989
Practice Address - Country:US
Practice Address - Phone:404-773-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer