Healthcare Provider Details

I. General information

NPI: 1205422995
Provider Name (Legal Business Name): SAMUEL CALZADA JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 COURTLANDT AVE
BRONX NY
10451-5013
US

IV. Provider business mailing address

579 COURTLANDT AVE
BRONX NY
10451-5013
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2100
  • Fax: 718-485-2101
Mailing address:
  • Phone: 718-485-2100
  • Fax: 718-485-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: