Provider Demographics
NPI:1679907216
Name:TAGAAN, LEMUEL OBACH (PT)
Entity Type:Individual
Prefix:MR
First Name:LEMUEL
Middle Name:OBACH
Last Name:TAGAAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 50TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3146
Mailing Address - Country:US
Mailing Address - Phone:347-840-4437
Mailing Address - Fax:
Practice Address - Street 1:4161 KISSENA BLVD
Practice Address - Street 2:CONCOURSE LEVEL SUITE 35
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3181
Practice Address - Country:US
Practice Address - Phone:917-285-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-31
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008764225200000X
NY036945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant