Provider Demographics
NPI:1891908778
Name:STAROSTIAK, LUBA L (PT)
Entity type:Individual
Prefix:MS
First Name:LUBA
Middle Name:L
Last Name:STAROSTIAK
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 1:667 SOUTH MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:974 ROUTE 45
Practice Address - Street 2:SUITE 1100
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3520
Practice Address - Country:US
Practice Address - Phone:845-517-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012548-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic