Provider Demographics
NPI:1053418764
Name:CABRERA, PEDRO
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:CABRERA
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 1:401 E 74TH ST
Mailing Address - Street 2:APT. 4-L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3919
Mailing Address - Country:US
Mailing Address - Phone:212-706-0680
Mailing Address - Fax:
Practice Address - Street 1:8268 164TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1121
Practice Address - Country:US
Practice Address - Phone:718-883-3225
Practice Address - Fax:718-883-6193
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189154207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NYF53457Medicare UPIN
NY00246075Medicaid