Provider Demographics
NPI:1780091249
Name:FISGUS, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:FISGUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PINEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-5216
Mailing Address - Country:US
Mailing Address - Phone:718-354-9421
Mailing Address - Fax:
Practice Address - Street 1:10 PINEBROOK RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-5216
Practice Address - Country:US
Practice Address - Phone:718-354-9421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist