Provider Demographics
NPI:1821045303
Name:MABIDA, MARK VINCENT CABALLERO (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK VINCENT
Middle Name:CABALLERO
Last Name:MABIDA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4243 147TH ST
Mailing Address - Street 2:APT. 2D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1247
Mailing Address - Country:US
Mailing Address - Phone:646-331-8588
Mailing Address - Fax:
Practice Address - Street 1:19413 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3032
Practice Address - Country:US
Practice Address - Phone:718-428-9369
Practice Address - Fax:718-423-9825
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY27988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist