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General NPI Number Information
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NPI Number | 1518478080
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Entity Type | Organization
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Legal Business Name | DIEGO G. CALABRIA PHYSICIAN P.C.
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 366 N BROADWAY STE 304
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City | JERICHO
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State | NY
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Zip | 11753-2000
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Country | US
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Telephone | 516-698-9980
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Fax | 516-214-6331
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Provider Business Mailing Address
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Address Line | 147 MAIN ST APT 3H
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City | MINEOLA
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State | NY
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Zip | 11501-3989
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. DIEGO GENNARO CALABRIA
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Credential | MD
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Telephone | 516-967-3583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 267694
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 267694
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License Number State | NY
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