Provider Demographics
NPI:1710110796
Name:BERDOS RUBA, CHERRYLENE ABULAG (PT)
Entity Type:Individual
Prefix:
First Name:CHERRYLENE
Middle Name:ABULAG
Last Name:BERDOS RUBA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 AUSTIN ST
Mailing Address - Street 2:STE 202
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4245
Mailing Address - Country:US
Mailing Address - Phone:718-896-0999
Mailing Address - Fax:718-896-8502
Practice Address - Street 1:6860 AUSTIN ST
Practice Address - Street 2:STE 202
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4245
Practice Address - Country:US
Practice Address - Phone:718-896-0999
Practice Address - Fax:718-896-8502
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist