Healthcare Provider Details

I. General information

NPI: 1598128035
Provider Name (Legal Business Name): DARREL CALLENDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HORIZON DR
HUNTINGTON NY
11743-4436
US

IV. Provider business mailing address

55 HORIZON DR
HUNTINGTON NY
11743-4436
US

V. Phone/Fax

Practice location:
  • Phone: 631-920-8347
  • Fax:
Mailing address:
  • Phone: 631-920-8347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: