Provider Demographics
NPI:1477520765
Name:INCABO, ELEAZAR VILORIA (PT)
Entity Type:Individual
Prefix:
First Name:ELEAZAR
Middle Name:VILORIA
Last Name:INCABO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:00146 TUNBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5404
Mailing Address - Country:US
Mailing Address - Phone:201-475-5606
Mailing Address - Fax:
Practice Address - Street 1:11 MEDICAL PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3559
Practice Address - Country:US
Practice Address - Phone:845-354-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-05
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist