Healthcare Provider Details

I. General information

NPI: 1518887769
Provider Name (Legal Business Name): CARL ALLEN VILLANUEVA CABRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 MEADE ST WEST ORANGE
WEST ORANGE NJ
07052
US

IV. Provider business mailing address

43 MEADE ST WEST ORANGE
WEST ORANGE NJ
07052
US

V. Phone/Fax

Practice location:
  • Phone: 347-829-3890
  • Fax: 247-829-3888
Mailing address:
  • Phone: 347-829-3890
  • Fax: 247-829-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: