Provider Demographics
NPI:1063808111
Name:LAGOY, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LAGOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 RIVER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2759
Mailing Address - Country:US
Mailing Address - Phone:201-264-6983
Mailing Address - Fax:
Practice Address - Street 1:1952 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1209
Practice Address - Country:US
Practice Address - Phone:203-672-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.9503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist