Provider Demographics
NPI:1255864484
Name:EARL, CALEB
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:EARL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHATSWORTH AVE
Mailing Address - Street 2:APT #3
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1452
Mailing Address - Country:US
Mailing Address - Phone:607-591-5688
Mailing Address - Fax:
Practice Address - Street 1:110 CHATSWORTH AVE
Practice Address - Street 2:APT #3
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1452
Practice Address - Country:US
Practice Address - Phone:607-591-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program