Healthcare Provider Details

I. General information

NPI: 1164867875
Provider Name (Legal Business Name): INTENSIVISTS AT WOONSOCKET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CASS AVE
WOONSOCKET RI
02895-4705
US

IV. Provider business mailing address

66 WEST GILBERT STREET 2ND FLOOR
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-4100
  • Fax: 732-212-0713
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH J CALABRO
Title or Position: PRESIDENT
Credential: DO
Phone: 732-212-0060