Healthcare Provider Details

I. General information

NPI: 1750497129
Provider Name (Legal Business Name): ROSA CALDERON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BROADWAY
PASSAIC NJ
07055-5007
US

IV. Provider business mailing address

7000 KENNEDY BLVD E APT 45A
WEST NEW YORK NJ
07093-4869
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-4600
  • Fax:
Mailing address:
  • Phone: 201-974-0077
  • Fax: 201-809-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07841700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: