Provider Demographics
NPI:1336763424
Name:EMANUEL, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:EMANUEL
Suffix:
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 1:2301 E EVESHAM RD STE 109
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4502
Mailing Address - Country:US
Mailing Address - Phone:609-332-0176
Mailing Address - Fax:
Practice Address - Street 1:2301 E EVESHAM RD STE 109
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4502
Practice Address - Country:US
Practice Address - Phone:917-651-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01371500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty