Provider Demographics
NPI:1629953229
Name:LETTLEY, LENZA MARIE
Entity type:Individual
Prefix:
First Name:LENZA
Middle Name:MARIE
Last Name:LETTLEY
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 1:1235 W CHESTNUT ST STE 243
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6830
Mailing Address - Country:US
Mailing Address - Phone:973-641-8755
Mailing Address - Fax:
Practice Address - Street 1:1235 W CHESTNUT ST STE 243
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6830
Practice Address - Country:US
Practice Address - Phone:973-641-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCSNXRIPBBG335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier