Provider Demographics
NPI:1407685225
Name:CUTAB, RON RONALD
Entity type:Individual
Prefix:
First Name:RON RONALD
Middle Name:
Last Name:CUTAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9306 43RD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2757
Mailing Address - Country:US
Mailing Address - Phone:646-842-4491
Mailing Address - Fax:
Practice Address - Street 1:157 GREENPOINT AVE # 11222
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-7099
Practice Address - Country:US
Practice Address - Phone:718-648-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty