Provider Demographics
NPI:1467770230
Name:CABAN, MARK DANIEL (RN)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DANIEL
Last Name:CABAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 JUPITER LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-6919
Mailing Address - Country:US
Mailing Address - Phone:518-689-2900
Mailing Address - Fax:518-689-2946
Practice Address - Street 1:91 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGBURG
Practice Address - State:NY
Practice Address - Zip Code:12721-4618
Practice Address - Country:US
Practice Address - Phone:845-733-1951
Practice Address - Fax:845-733-1951
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628036163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse