Provider Demographics
NPI:1467633040
Name:HOPE PHYSICAL MEDICINE & REHABILITATION, PC
Entity Type:Organization
Organization Name:HOPE PHYSICAL MEDICINE & REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:ACEBO
Authorized Official - Last Name:CUBANGBANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-270-2755
Mailing Address - Street 1:894 OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1936
Mailing Address - Country:US
Mailing Address - Phone:516-270-2755
Mailing Address - Fax:516-270-2755
Practice Address - Street 1:5123 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4587
Practice Address - Country:US
Practice Address - Phone:718-458-5333
Practice Address - Fax:718-458-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-24
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-061044208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02623398Medicaid
NY1467633040OtherNPI
NY1467633040OtherNPI
NY6363910001Medicare NSC