Provider Demographics
NPI:1265741367
Name:LENARD, COLLEEN LISA (PA-C)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:LISA
Last Name:LENARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:732-842-0673
Mailing Address - Fax:732-842-7352
Practice Address - Street 1:180 WHITE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1166
Practice Address - Country:US
Practice Address - Phone:732-842-0673
Practice Address - Fax:732-842-7352
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00246000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical