MEDICARE: DR. KATHRYN ELISE CALABRIA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	A169270	NY

General Provider Information

NPI Number	:	1174633903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN ELISE CALABRIA D.O.

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

Provider Business Practice Location Address
First Line	:	1101 STEWART AVE
Second Line	:	SUITE 1ES
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-4892
Country	:	US
Telephone Number	:	631-776-0432
Fax Number	:	516-227-5373

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/03/2009

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