Provider Demographics
NPI:1942949953
Name:HIDENHEIM, EILEEN DOLORES I
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:DOLORES
Last Name:HIDENHEIM
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2751
Mailing Address - Country:US
Mailing Address - Phone:267-907-2849
Mailing Address - Fax:
Practice Address - Street 1:3100 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1658
Practice Address - Country:US
Practice Address - Phone:609-584-6640
Practice Address - Fax:609-631-6836
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00261300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist