MEDICARE: MAYCK A CALLE MORAN

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	225100000X	Physical Therapist		NJ

General Provider Information

NPI Number	:	1881559250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYCK A CALLE MORAN

Provider Business Mailing Address
First Line	:	301 ROUTE 17
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2575
Country	:	US
Telephone Number	:	201-460-0032
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 ROUTE 17
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2575
Country	:	US
Telephone Number	:	201-460-0032
Fax Number	:

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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Directions to “ MAYCK A CALLE MORAN ” Practice Location

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