Provider Demographics
NPI:1265289946
Name:HENRY, MEGHAN CHRISTINE
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:CHRISTINE
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:CHRISTINE
Other - Last Name:LILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11106 CRYSTAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6493
Mailing Address - Country:US
Mailing Address - Phone:908-910-9796
Mailing Address - Fax:
Practice Address - Street 1:279 BROWERTOWN RD STE 108
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2663
Practice Address - Country:US
Practice Address - Phone:973-420-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00413600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant