1770582124 NPI number — DR. DANTE ACEBO CUBANGBANG M.D.

Table of content: DR. DANTE ACEBO CUBANGBANG M.D. (NPI 1770582124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770582124 NPI number — DR. DANTE ACEBO CUBANGBANG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUBANGBANG
Provider First Name:
DANTE
Provider Middle Name:
ACEBO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770582124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
894 OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN SQUARE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11010-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-930-9614
Provider Business Mailing Address Fax Number:
516-270-2755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13915 34TH AVE
Provider Second Line Business Practice Location Address:
BASEMENT OFFICE
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354-3046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-542-3435
Provider Business Practice Location Address Fax Number:
347-542-3539
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  234017 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02623398 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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