Healthcare Provider Details

I. General information

NPI: 1346764727
Provider Name (Legal Business Name): ROEL PAULO CABAHUG IMPERIO RN FIRST ASSIST RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROBERT WOOD JOHNSON PL
NEW BRUNSWICK NJ
08901-1928
US

IV. Provider business mailing address

28 BARTMAN RD
EAST BRUNSWICK NJ
08816-4639
US

V. Phone/Fax

Practice location:
  • Phone: 732-828-3000
  • Fax:
Mailing address:
  • Phone: 732-421-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NR1185300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: