Provider Demographics
NPI:1609935527
Name:CARDILLO, DAVID CHARLES (CPED)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHARLES
Last Name:CARDILLO
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 BRIGHTON HENRIETTA TOWN LINE RD.
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2813
Mailing Address - Country:US
Mailing Address - Phone:585-473-5950
Mailing Address - Fax:585-473-9596
Practice Address - Street 1:3385 BRIGHTON HENRIETTA TOWN LINE RD.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2813
Practice Address - Country:US
Practice Address - Phone:585-473-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02350998Medicaid
NY0875010001Medicare NSC