Provider Demographics
NPI:1124074067
Name:LEGASPI, OWEN (PT)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:LEGASPI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S LIVINGSTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5419
Mailing Address - Country:US
Mailing Address - Phone:973-992-0733
Mailing Address - Fax:973-992-0734
Practice Address - Street 1:600 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-992-0733
Practice Address - Fax:973-992-0734
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00798700208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083473Medicare ID - Type Unspecified