Provider Demographics
NPI:1003817933
Name:PPE-KEYSTONE, P.C.
Entity Type:Organization
Organization Name:PPE-KEYSTONE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CALABRO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-212-0060
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:100 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2170
Practice Address - Country:US
Practice Address - Phone:570-281-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA677832OtherBLUE SHIELD
PA0017817450007Medicaid
PA220655OtherFIRST PRIORITY HEALTH
PA2501137OtherGHI
PACK9004OtherRAILROAD MEDICARE
PA02123279OtherN.Y. MEDICAID
PACL6905OtherRAILROAD MEDICARE
PA0017817450005Medicaid
PA6109OtherGEISINGER (MARIAN)
PA0511396000OtherINDEPENDENCE BLUE
PA3Y0309OtherHEALTH NET:
PACH1536OtherRAILROAD MEDICARE
PA6960OtherGEISINGER (WAYNE LOCATIO)
NJ034814Medicare PIN