Provider Demographics
NPI:1720579345
Name:TABO, LIBERTINE MAGALON
Entity Type:Individual
Prefix:
First Name:LIBERTINE
Middle Name:MAGALON
Last Name:TABO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 WEST 37TH STREET
Mailing Address - Street 2:SUITE 660
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-5707
Mailing Address - Country:US
Mailing Address - Phone:718-885-7899
Mailing Address - Fax:
Practice Address - Street 1:2825 3RD AVENUE APT #4
Practice Address - Street 2:CENTRAL PARK PHYSICAL MEDICINE AND REHABILITATION, P.C.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4066
Practice Address - Country:US
Practice Address - Phone:718-401-3000
Practice Address - Fax:718-892-8610
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist