Provider Demographics
NPI:1376861963
Name:LEIBOWITZ, ILENE (PT)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:
Last Name:LEIBOWITZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 HUDSON MANOR TER APT 1CE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1133
Mailing Address - Country:US
Mailing Address - Phone:917-617-3348
Mailing Address - Fax:
Practice Address - Street 1:3750 HUDSON MANOR TER APT 1CE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1133
Practice Address - Country:US
Practice Address - Phone:917-617-3348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist