Provider Demographics
NPI:1558130955
Name:CABANTUG, VENNIE NINO
Entity Type:Individual
Prefix:
First Name:VENNIE NINO
Middle Name:
Last Name:CABANTUG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E 117TH ST APT 5N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4624
Mailing Address - Country:US
Mailing Address - Phone:323-532-7671
Mailing Address - Fax:
Practice Address - Street 1:1339 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4707
Practice Address - Country:US
Practice Address - Phone:212-628-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY838753163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse