Healthcare Provider Details

I. General information

NPI: 1356364863
Provider Name (Legal Business Name): MICHAEL FREDERICK CABBAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL FREDERICK CABBAD MD

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE
STATEN ISLAND NY
10310-1664
US

IV. Provider business mailing address

355 BARD AVE
STATEN ISLAND NY
10310-1699
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-2979
  • Fax:
Mailing address:
  • Phone: 718-818-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number143822
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: