Provider Demographics
NPI:1235775164
Name:CARDENAS, CHRISTIAN (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7119 80TH ST STE 8210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7733
Mailing Address - Country:US
Mailing Address - Phone:718-554-6610
Mailing Address - Fax:718-360-4908
Practice Address - Street 1:12308 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2710
Practice Address - Country:US
Practice Address - Phone:718-880-2385
Practice Address - Fax:718-880-2386
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY261092629OtherTIN