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General NPI Number Information
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NPI Number | 1871871483
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Entity Type | Organization
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Legal Business Name | FIRST PREMIER CARE MEDICAL, P.C.
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Dates
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Enumeration Date | 07/30/2011
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Last Update Date | 07/30/2011
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Provider Practice Location Address
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Address Line | 20607 HILLSIDE AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1709
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Country | US
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Telephone | 917-929-8589
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Fax | 516-270-2755
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Provider Business Mailing Address
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Address Line | 894 OAKS DR
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-1936
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Country | US
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Telephone | 917-929-8589
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Fax | 516-270-2755
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Authorized Official
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Title or Position | DIRECTOR/ PRESIDENT
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Name | DR. DANTE ACEBO CUBANGBANG
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Credential | MD
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Telephone | 917-929-8589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 090193
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License Number State | NY
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