Provider Demographics
NPI:1821296971
Name:ALBUQUERQUE, LESLY Y (PT)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:Y
Last Name:ALBUQUERQUE
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 1:154 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1003
Mailing Address - Country:US
Mailing Address - Phone:862-812-6433
Mailing Address - Fax:973-726-3264
Practice Address - Street 1:798 WILLOW GROVE ST
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1718
Practice Address - Country:US
Practice Address - Phone:908-852-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA0119210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist