Edward Gerard De Pedro Tabuada

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

013214-01 Issued in NY

Practice address

1084 Liberty Ave
Brooklyn, NY 11208-2923

Phone

(347) 586-0625

NPI assigned

Apr 17, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681689600000",
    "number": "1043906696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1084 LIBERTY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112082923",
            "telephone_number": "347-586-0625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1084 LIBERTY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112082923",
            "telephone_number": "347-586-0625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABUADA",
        "first_name": "EDWARD GERARD",
        "middle_name": "DE PEDRO",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "013214-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prudencio G. Tablang, M.D.
• Tablet RX Corp
• Treasure Tabor
• Chana Tabrikian
• Ryan Tabtabai, MD
• Jessica Tabuada, P.T.
• Armelle Tabuteau
• Juliana Marie Taccetta, OTR/L
• Chana Tach, MSED
• Elena Tachman, CRNA

• Physical Therapy Assistant in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.