1194504522 NPI number — CHRISTIAN EDWIN CABRERA BALUYUT PT

Table of content: CHRISTIAN EDWIN CABRERA BALUYUT PT (NPI 1194504522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194504522 NPI number — CHRISTIAN EDWIN CABRERA BALUYUT PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALUYUT
Provider First Name:
CHRISTIAN
Provider Middle Name:
EDWIN CABRERA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1194504522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 WATERS PL STE 501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10461-2732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-374-7288
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
244 W 54TH ST
Provider Second Line Business Practice Location Address:
STE 404
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-5556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-507-0477
Provider Business Practice Location Address Fax Number:
845-507-0490
Provider Enumeration Date:
09/25/2023

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: 225100000X , with the licence number:  051252 , 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)





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