Provider Demographics
NPI:1194712372
Name:HAGAN, ELEANOR MARGARET (PT, MPT)
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:MARGARET
Last Name:HAGAN
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JENNY LYNN DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1532
Mailing Address - Country:US
Mailing Address - Phone:609-645-5058
Mailing Address - Fax:609-645-9459
Practice Address - Street 1:2 JENNY LYNN DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1532
Practice Address - Country:US
Practice Address - Phone:609-412-4449
Practice Address - Fax:609-645-9459
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00915700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043068Medicare UPIN