Provider Demographics
NPI:1023341872
Name:ROSA CALDERON SERVICES
Entity type:Organization
Organization Name:ROSA CALDERON SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-598-1110
Mailing Address - Street 1:7100 KENNEDY BLVD E APT 7F
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4722
Mailing Address - Country:US
Mailing Address - Phone:201-598-1110
Mailing Address - Fax:201-227-9509
Practice Address - Street 1:15 BROADWAY
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5007
Practice Address - Country:US
Practice Address - Phone:201-598-1110
Practice Address - Fax:201-227-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07841700305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization