Provider Demographics
NPI:1922343078
Name:CANCEL, DAVID (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:CANCEL
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PIER POINTE ST
Mailing Address - Street 2:APT 517
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3569
Mailing Address - Country:US
Mailing Address - Phone:718-430-8500
Mailing Address - Fax:
Practice Address - Street 1:1410 PELHAM PKWY S
Practice Address - Street 2:ROOM 110
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1116
Practice Address - Country:US
Practice Address - Phone:718-430-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269076-1208100000X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation