Provider Demographics
NPI:1134324122
Name:CUBILLAN, WILBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:WILBERT
Middle Name:
Last Name:CUBILLAN
Suffix:
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 1:15928 92ND ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3122
Mailing Address - Country:US
Mailing Address - Phone:718-529-4384
Mailing Address - Fax:
Practice Address - Street 1:210 E SUNRISE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1329
Practice Address - Country:US
Practice Address - Phone:516-596-2273
Practice Address - Fax:516-596-9606
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist