Provider Demographics
NPI:1699848234
Name:CAVALLARO, VINCENT JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:CAVALLARO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 BOYNTON PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4632
Mailing Address - Country:US
Mailing Address - Phone:718-996-1767
Mailing Address - Fax:718-232-5048
Practice Address - Street 1:7608 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2510
Practice Address - Country:US
Practice Address - Phone:718-259-0900
Practice Address - Fax:718-232-5048
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0069911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ55342Medicare ID - Type Unspecified