Basic Information
| Provider Information | |||||||||
| NPI: | 1104254903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIAN AT NEWBURGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 W GILBERT ST | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077014947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7321210060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 70 DUBOIS ST | ||||||||
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| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125504851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455614400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2013 | ||||||||
| LastUpdateDate: | 10/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | CALABRO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7322120060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.