Provider Demographics
NPI:1124592530
Name:CABAN, ADRIAN (LMT)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:CABAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SEELEY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1066
Mailing Address - Country:US
Mailing Address - Phone:347-419-3422
Mailing Address - Fax:
Practice Address - Street 1:90 CLINTON AVE APT 204
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-2012
Practice Address - Country:US
Practice Address - Phone:347-419-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028168-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty