1518478080 NPI number — DIEGO G. CALABRIA PHYSICIAN P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518478080 NPI number — DIEGO G. CALABRIA PHYSICIAN P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIEGO G. CALABRIA PHYSICIAN P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1518478080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
147 MAIN ST APT 3H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-3989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
366 N BROADWAY STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERICHO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11753-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-698-9980
Provider Business Practice Location Address Fax Number:
516-214-6331
Provider Enumeration Date:
10/23/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CALABRIA
Authorized Official First Name:
DIEGO
Authorized Official Middle Name:
GENNARO
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
516-967-3583

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  267694 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 267694 , 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)

  • Identifier: 03808826 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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