Provider Demographics
NPI:1174214308
Name:UMANDAP, ROBERT WILLIAM JR CARDENAS (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT WILLIAM JR
Middle Name:CARDENAS
Last Name:UMANDAP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 FRESH POND RD STE 1
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5200
Mailing Address - Country:US
Mailing Address - Phone:929-299-6505
Mailing Address - Fax:718-799-9191
Practice Address - Street 1:6805 FRESH POND RD STE 1
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5200
Practice Address - Country:US
Practice Address - Phone:929-299-6505
Practice Address - Fax:718-799-9191
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042068OtherLICENSE