Provider Demographics
NPI:1770582124
Name:CUBANGBANG, DANTE ACEBO (MD)
Entity type:Individual
Prefix:DR
First Name:DANTE
Middle Name:ACEBO
Last Name:CUBANGBANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:894 OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1936
Mailing Address - Country:US
Mailing Address - Phone:917-930-9614
Mailing Address - Fax:516-270-2755
Practice Address - Street 1:13915 34TH AVE
Practice Address - Street 2:BASEMENT OFFICE
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3046
Practice Address - Country:US
Practice Address - Phone:347-542-3435
Practice Address - Fax:347-542-3539
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY234017208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02623398Medicaid
NY02623398Medicaid
NYI18741Medicare UPIN
NYIA0615Medicare ID - Type Unspecified
NY06898Medicare ID - Type Unspecified