Provider Demographics
NPI:1265527949
Name:LENNY, EDMUND JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:JOSEPH
Last Name:LENNY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 MARLTON PIKE E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2230
Mailing Address - Country:US
Mailing Address - Phone:856-616-1060
Mailing Address - Fax:856-616-1062
Practice Address - Street 1:1430 MARLTON PIKE E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2230
Practice Address - Country:US
Practice Address - Phone:856-616-1060
Practice Address - Fax:856-616-1062
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA003257002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ644228Medicare ID - Type Unspecified