Healthcare Provider Details

I. General information

NPI: 1942202775
Provider Name (Legal Business Name): OLGA CALDERON-BANZON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTRAL AVE
EAST ORANGE NJ
07018-2819
US

IV. Provider business mailing address

66 W GILBERT ST SUITE 100
TINTON FALLS NJ
07701-4918
US

V. Phone/Fax

Practice location:
  • Phone: 973-672-8400
  • Fax:
Mailing address:
  • Phone: 721-212-0060
  • Fax: 732-212-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA02802200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: