Individual
PHILLIP LANEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
317 SIMONS AVE, HACKENSACK, NJ 07601-1817
(201) 881-6217
Mailing address
317 SIMONS AVE, HACKENSACK, NJ 07601-1817
(201) 881-6217
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00363800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40QB00363800
—
NJ
Enumeration date
11/23/2020
Last updated
11/23/2020
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