Healthcare Provider Details

I. General information

NPI: 1194504522
Provider Name (Legal Business Name): CHRISTIAN EDWIN CABRERA BALUYUT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 W 54TH ST STE 404
NEW YORK NY
10019-5556
US

IV. Provider business mailing address

1250 WATERS PL STE 501
BRONX NY
10461-2732
US

V. Phone/Fax

Practice location:
  • Phone: 845-507-0477
  • Fax: 845-507-0490
Mailing address:
  • Phone: 951-374-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number051252
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: