Healthcare Provider Details

I. General information

NPI: 1972569671
Provider Name (Legal Business Name): CAROL ELIZABETH CALABRESE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 11/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328A SPARTA AVE
SPARTA NJ
07871
US

IV. Provider business mailing address

LB # 7550 PO BOX 95000
PHILADELPHIA PA
19195-7550
US

V. Phone/Fax

Practice location:
  • Phone: 973-729-2197
  • Fax: 973-729-3653
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA050799
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD044378L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: