Provider Demographics
NPI:1851466775
Name:CAJITA, DENNIS BAUTISTA (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:BAUTISTA
Last Name:CAJITA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481A FR. CAPODANNO BLVD.
Mailing Address - Street 2:STE. 1
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-720-3790
Mailing Address - Fax:718-720-1238
Practice Address - Street 1:27-51 27TH ST.
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:718-728-0612
Practice Address - Fax:718-545-7771
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP43983Medicare UPIN