Provider Demographics
NPI:1538863196
Name:CAUSIN, PHOEBE MARIGEL GARGANERA
Entity type:Individual
Prefix:
First Name:PHOEBE MARIGEL
Middle Name:GARGANERA
Last Name:CAUSIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 65TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2859
Mailing Address - Country:US
Mailing Address - Phone:951-710-7445
Mailing Address - Fax:
Practice Address - Street 1:2865 BRIGHTON 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6762
Practice Address - Country:US
Practice Address - Phone:718-891-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04101601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist