Healthcare Provider Details

I. General information

NPI: 1518478080
Provider Name (Legal Business Name): DIEGO G. CALABRIA PHYSICIAN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 N BROADWAY STE 304
JERICHO NY
11753-2000
US

IV. Provider business mailing address

147 MAIN ST APT 3H
MINEOLA NY
11501-3989
US

V. Phone/Fax

Practice location:
  • Phone: 516-698-9980
  • Fax: 516-214-6331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number267694
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number267694
License Number StateNY

VIII. Authorized Official

Name: DR. DIEGO GENNARO CALABRIA
Title or Position: MD/OWNER
Credential: MD
Phone: 516-967-3583