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General NPI Number Information
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NPI Number | 1093295537
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Entity Type | Individual
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Provider Name | CASEY JACKSON CALABRESE DPT
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Gender | Male
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 656 ELMWOOD AVE
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City | BUFFALO
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State | NY
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Zip | 14222
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Country | US
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Telephone | 716-883-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 8985 CLARENCE CENTER RD
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City | CLARENCE CENTER
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State | NY
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Zip | 14032-9756
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Country | US
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Telephone | 716-906-0377
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 044120
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License Number State | NY
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