MEDICARE: MR. MARK DANIEL CABAN RN

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
1	163W00000X	Registered Nurse	628036	NY

General Provider Information

NPI Number	:	1467770230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK DANIEL CABAN RN

Provider Business Mailing Address
First Line	:	12 JUPITER LN
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-6919
Country	:	US
Telephone Number	:	518-689-2900
Fax Number	:	518-689-2946

Provider Business Practice Location Address
First Line	:	91 OLD TURNPIKE RD
Second Line	:
City	:	BLOOMINGBURG
State	:	NY
Zip	:	12721-4618
Country	:	US
Telephone Number	:	845-733-1951
Fax Number	:	845-733-1951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	05/13/2015

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