Provider Demographics
NPI:1750035523
Name:UMBAY, IRIS CLAIRE PEPITO (PT)
Entity Type:Individual
Prefix:
First Name:IRIS CLAIRE
Middle Name:PEPITO
Last Name:UMBAY
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 1:16336 88TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3344
Mailing Address - Country:US
Mailing Address - Phone:510-518-8616
Mailing Address - Fax:
Practice Address - Street 1:13104 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-3124
Practice Address - Country:US
Practice Address - Phone:718-322-2269
Practice Address - Fax:718-322-4697
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist