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NPI Code Detail

MEDICARE: MR. JOSE JONATHAN CANCINO P.T.

MEDICARE: MR. JOSE JONATHAN CANCINO P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist019761-1NY

General Provider Information

NPI Number : 1346287703
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSE JONATHAN CANCINO P.T.
Provider Business Mailing Address
First Line : 372 CATOR AVE
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07305-2055
Country : US
Telephone Number : 201-761-0136
Fax Number : 631-467-0928
Provider Business Practice Location Address
First Line : 20 PEACHTREE CT
Second Line : #105
City : HOLBROOK
State : NY
Zip : 11741-4616
Country : US
Telephone Number : 631-467-3700
Fax Number : 631-467-0928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 10/12/2007

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