Healthcare Provider Details

I. General information

NPI: 1750467049
Provider Name (Legal Business Name): DINORAH CALDERON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOBART ST
PERTH AMBOY NJ
08861-3396
US

IV. Provider business mailing address

PO BOX 1220 ATTN; HR/CREDENTIALING
PERTH AMBOY NJ
08862-3396
US

V. Phone/Fax

Practice location:
  • Phone: 732-376-9333
  • Fax: 732-324-5765
Mailing address:
  • Phone: 732-376-9333
  • Fax: 732-324-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07404800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number229601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: