Healthcare Provider Details

I. General information

NPI: 1902315377
Provider Name (Legal Business Name): JOHANN ERIC CASALLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 38TH ST FL 6
NEW YORK NY
10018-9537
US

IV. Provider business mailing address

307 W 38TH ST FL 6
NEW YORK NY
10018-9537
US

V. Phone/Fax

Practice location:
  • Phone: 212-695-5441
  • Fax: 212-695-4561
Mailing address:
  • Phone: 212-695-5441
  • Fax: 212-695-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: