Provider Demographics
NPI:1730054263
Name:PABON, RAFAEL (LMT)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:PABON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W 54TH ST # 804
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5502
Mailing Address - Country:US
Mailing Address - Phone:212-600-4808
Mailing Address - Fax:
Practice Address - Street 1:240 W 54TH ST # 804
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5502
Practice Address - Country:US
Practice Address - Phone:212-600-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032061-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist