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General NPI Number Information
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NPI Number | 1629224647
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Entity Type | Individual
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Provider Name | LEONARD JESUS SOMARRIBA
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Gender | Male
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Dates
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Enumeration Date | 08/10/2008
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Last Update Date | 05/19/2013
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Provider Practice Location Address
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Address Line | 1212 HIGHWAY 34 SUITE 24/25
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City | ABERDEEN
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State | NJ
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Zip | 07747-1903
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Country | US
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Telephone | 561-676-3565
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Fax |
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Provider Business Mailing Address
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Address Line | 458 S LIVINGSTON AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4328
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Country | US
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Telephone | 561-676-3565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 04001234000
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License Number State | NJ
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