Provider Demographics
NPI:1679806509
Name:LENSKOLD, MARY HOPE (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HOPE
Last Name:LENSKOLD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5935
Mailing Address - Country:US
Mailing Address - Phone:732-483-1800
Mailing Address - Fax:732-483-1622
Practice Address - Street 1:194 ROUTE 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5935
Practice Address - Country:US
Practice Address - Phone:732-483-1800
Practice Address - Fax:732-483-1622
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00222600363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical