Provider Demographics
NPI:1346287703
Name:CANCINO, JOSE JONATHAN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:JONATHAN
Last Name:CANCINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:372 CATOR AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2055
Mailing Address - Country:US
Mailing Address - Phone:201-761-0136
Mailing Address - Fax:631-467-0928
Practice Address - Street 1:20 PEACHTREE CT
Practice Address - Street 2:#105
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4616
Practice Address - Country:US
Practice Address - Phone:631-467-3700
Practice Address - Fax:631-467-0928
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY019761-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist