=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619717394
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FINELA DAEDRE PUA CABANDING PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2024
-----------------------------------------------------
Last Update Date | 05/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22809 64TH AVE FL 1
-----------------------------------------------------
City | OAKLAND GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11364-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-496-7700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22809 64TH AVE FL 1
-----------------------------------------------------
City | OAKLAND GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11364-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 049405
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------