Provider Demographics
NPI:1407577141
Name:HENDI, AHMED SAMIR SR (LMT)
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:SAMIR
Last Name:HENDI
Suffix:SR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 KENNEDY BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3416
Mailing Address - Country:US
Mailing Address - Phone:929-628-7105
Mailing Address - Fax:
Practice Address - Street 1:3220 KENNEDY BLVD FL 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3416
Practice Address - Country:US
Practice Address - Phone:929-628-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KTOO676600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty