Provider Demographics
NPI:1043234289
Name:CABALLERO, CARLOS ABES
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ABES
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CEDAR GROVE LN
Mailing Address - Street 2:SUITE 35
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1331
Mailing Address - Country:US
Mailing Address - Phone:732-563-0070
Mailing Address - Fax:
Practice Address - Street 1:7 CEDAR GROVE LN
Practice Address - Street 2:SUITE 35
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1331
Practice Address - Country:US
Practice Address - Phone:732-563-0070
Practice Address - Fax:732-563-0025
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00799000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ060275T5WMedicare ID - Type Unspecified