Healthcare Provider Details

I. General information

NPI: 1174214308
Provider Name (Legal Business Name): ROBERT WILLIAM JR CARDENAS UMANDAP PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6805 FRESH POND RD STE 1
RIDGEWOOD NY
11385-5200
US

IV. Provider business mailing address

6805 FRESH POND RD STE 1
RIDGEWOOD NY
11385-5200
US

V. Phone/Fax

Practice location:
  • Phone: 929-299-6505
  • Fax: 718-799-9191
Mailing address:
  • Phone: 929-299-6505
  • Fax: 718-799-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number042068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: