Provider Demographics
NPI:1336921022
Name:HABOC, LEOPOLDO JUNIOR GONCERO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:LEOPOLDO JUNIOR
Middle Name:GONCERO
Last Name:HABOC
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15606 78TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2527
Mailing Address - Country:US
Mailing Address - Phone:929-601-6277
Mailing Address - Fax:
Practice Address - Street 1:15606 78TH ST APT 2
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2527
Practice Address - Country:US
Practice Address - Phone:929-601-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist