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NPI Code Detail

MEDICARE: RICHARD CABELLO PTA

MEDICARE: RICHARD CABELLO PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant005145NY

General Provider Information

NPI Number : 1063761831
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD CABELLO PTA
Provider Business Mailing Address
First Line : 31 NEW DORP LN
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-2351
Country : US
Telephone Number : 718-370-3500
Fax Number : 718-979-5236
Provider Business Practice Location Address
First Line : 31 NEW DORP LN
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-2351
Country : US
Telephone Number : 718-370-3500
Fax Number : 718-979-5236
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2012
Last Update Date : 09/07/2012

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