Basic Information
| Provider Information | |||||||||
| NPI: | 1295025799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALDERON | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2602 NEW YORK AVE | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070874621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3478345996 | ||||||||
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| Practice Location | |||||||||
| Address1: | 520 E 70TH ST # 403 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100219800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607467576 | ||||||||
| FaxNumber: | 2127468246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2011 | ||||||||
| LastUpdateDate: | 04/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 014527 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.