MEDICARE: RENAE CALVARIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1285860866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENAE CALVARIO

Provider Business Mailing Address
First Line	:	PO BOX 437
Second Line	:
City	:	SPARROW BUSH
State	:	NY
Zip	:	12780-0437
Country	:	US
Telephone Number	:	845-858-8294
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 OLD CAHOONZIE RD
Second Line	:
City	:	SPARROW BUSH
State	:	NY
Zip	:	12780-5522
Country	:	US
Telephone Number	:	845-858-8294
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	06/09/2009

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Directions to “ RENAE CALVARIO ” Practice Location

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