Healthcare Provider Details

I. General information

NPI: 1316330053
Provider Name (Legal Business Name): LEBIAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 04/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SOLAR DR C
CLIFTON PARK NY
12065-3402
US

IV. Provider business mailing address

11 SOLAR DR C
CLIFTON PARK NY
12065-3402
US

V. Phone/Fax

Practice location:
  • Phone: 518-406-8788
  • Fax:
Mailing address:
  • Phone: 518-406-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number012126
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number024782
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number026344
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number024220
License Number StateNY

VIII. Authorized Official

Name: IAN HOGAN
Title or Position: PRESIDENT
Credential: LMT
Phone: 518-406-8788