Healthcare Provider Details

I. General information

NPI: 1962444976
Provider Name (Legal Business Name): TROY EZRA CALLAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PL STE 405
ENGLEWOOD NJ
07631-4960
US

IV. Provider business mailing address

25 ROCKWOOD PL STE 405
ENGLEWOOD NJ
07631-4960
US

V. Phone/Fax

Practice location:
  • Phone: 201-225-1811
  • Fax: 201-616-7789
Mailing address:
  • Phone: 201-225-1811
  • Fax: 201-616-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number206666-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MA0811800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: