Basic Information
| Provider Information | |||||||||
| NPI: | 1982166989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABRAL | ||||||||
| FirstName: | ROBERTO | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 SAINT ANDREWS LN | ||||||||
| Address2: | |||||||||
| City: | GLEN COVE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115422254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166747631 | ||||||||
| FaxNumber: | 5166747639 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | EAST PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117728809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312285801 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2019 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.