1174633903 NPI number — DR. KATHRYN ELISE CALABRIA D.O.

Table of content: DR. KATHRYN ELISE CALABRIA D.O. (NPI 1174633903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174633903 NPI number — DR. KATHRYN ELISE CALABRIA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALABRIA
Provider First Name:
KATHRYN
Provider Middle Name:
ELISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174633903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2797 MONTAUK HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKHAVEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11719-9596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-776-0432
Provider Business Mailing Address Fax Number:
631-803-6064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 STEWART AVE
Provider Second Line Business Practice Location Address:
SUITE 1ES
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11530-4892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-776-0432
Provider Business Practice Location Address Fax Number:
516-227-5373
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  A169270 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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