Provider Demographics
NPI:1346495199
Name:CAGATA, MARK CELESTIE ORNOPIA (RPT, DPT)
Entity Type:Individual
Prefix:MR
First Name:MARK CELESTIE
Middle Name:ORNOPIA
Last Name:CAGATA
Suffix:
Gender:M
Credentials:RPT, DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:55 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2634
Mailing Address - Country:US
Mailing Address - Phone:347-331-1051
Mailing Address - Fax:
Practice Address - Street 1:21530 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1831
Practice Address - Country:US
Practice Address - Phone:718-776-1863
Practice Address - Fax:718-732-2161
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist