Provider Demographics
NPI:1033209358
Name:DABOVICH, JOSEPH PAUL II (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PAUL
Last Name:DABOVICH
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 JUDY TER
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3724
Mailing Address - Country:US
Mailing Address - Phone:516-721-3167
Mailing Address - Fax:516-795-1520
Practice Address - Street 1:21 JUDY TER
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3724
Practice Address - Country:US
Practice Address - Phone:516-721-3167
Practice Address - Fax:516-795-1520
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ06T61Medicare UPIN