=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205081759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I CARE PT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2008
-----------------------------------------------------
Last Update Date | 11/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 164 BRIGHTON 11TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-5327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-379-4414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 164 BRIGHTON 11TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-5327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-379-4414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EDWIN C CABRERA
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 917-379-4414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 019519
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------