Provider Demographics
NPI:1669565917
Name:ROBERT CALIFANO
Entity type:Organization
Organization Name:ROBERT CALIFANO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CALIFANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-785-1110
Mailing Address - Street 1:713 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2490
Mailing Address - Country:US
Mailing Address - Phone:518-785-1110
Mailing Address - Fax:518-785-1923
Practice Address - Street 1:713 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 222
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2490
Practice Address - Country:US
Practice Address - Phone:518-785-1110
Practice Address - Fax:518-785-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3854213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA058OtherCDPHP
NY40082BMedicare ID - Type Unspecified