Provider Demographics
NPI:1518150606
Name:LENNON, OWEN M (DPT)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:M
Last Name:LENNON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 BRIGHTON RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1663
Mailing Address - Country:US
Mailing Address - Phone:973-928-6969
Mailing Address - Fax:973-928-6968
Practice Address - Street 1:2 BRIGHTON RD
Practice Address - Street 2:SUITE 406
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1663
Practice Address - Country:US
Practice Address - Phone:973-928-6969
Practice Address - Fax:973-928-6968
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPT3289225100000X
NJ40QA01391100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist