Provider Demographics
NPI:1538777651
Name:LAGUMBAY, LEAH QUIETA
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:QUIETA
Last Name:LAGUMBAY
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 1:43 SMITHTOWN POLK BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3218
Mailing Address - Country:US
Mailing Address - Phone:201-885-9527
Mailing Address - Fax:
Practice Address - Street 1:10015 QUEENS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2465
Practice Address - Country:US
Practice Address - Phone:347-813-4960
Practice Address - Fax:347-813-4960
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0324292251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics