Provider Demographics
NPI:1417072737
Name:MENKIN, LOIS (MA,OTR)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:
Last Name:MENKIN
Suffix:
Gender:F
Credentials:MA,OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MOSS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2853
Mailing Address - Country:US
Mailing Address - Phone:908-518-9248
Mailing Address - Fax:
Practice Address - Street 1:1400 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3362
Practice Address - Country:US
Practice Address - Phone:908-753-1113
Practice Address - Fax:908-753-9558
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00020300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist