Provider Demographics
NPI:1972706018
Name:CABITAC, JESUS JOSEF TIAMZON JR (PT)
Entity type:Individual
Prefix:MR
First Name:JESUS JOSEF
Middle Name:TIAMZON
Last Name:CABITAC
Suffix:JR
Gender:M
Credentials:PT
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Mailing Address - Street 1:143 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4111
Mailing Address - Country:US
Mailing Address - Phone:917-916-6745
Mailing Address - Fax:516-837-0882
Practice Address - Street 1:143 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4111
Practice Address - Country:US
Practice Address - Phone:917-916-6745
Practice Address - Fax:516-837-0882
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2025-01-20
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Provider Licenses
StateLicense IDTaxonomies
NY023341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist