Provider Demographics
NPI:1629224647
Name:SOMARRIBA, LEONARD JESUS
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:JESUS
Last Name:SOMARRIBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 S LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4328
Mailing Address - Country:US
Mailing Address - Phone:561-676-3565
Mailing Address - Fax:
Practice Address - Street 1:1212 HIGHWAY 34
Practice Address - Street 2:SUITE 24/25
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1903
Practice Address - Country:US
Practice Address - Phone:561-676-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-10
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ040012340002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic