Healthcare Provider Details

I. General information

NPI: 1760300172
Provider Name (Legal Business Name): AUSTIN LEBO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 LONG BEACH RD
OCEANSIDE NY
11572-2044
US

IV. Provider business mailing address

325 E PENN ST APT GROUND
LONG BEACH NY
11561-4331
US

V. Phone/Fax

Practice location:
  • Phone: 516-613-2501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: