Provider Demographics
NPI:1275853897
Name:DE LA CALZADA-JEANLOUIE, MAE FAYE (DO)
Entity Type:Individual
Prefix:DR
First Name:MAE
Middle Name:FAYE
Last Name:DE LA CALZADA-JEANLOUIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MAE
Other - Middle Name:FAYE
Other - Last Name:DE LA CALZADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:16 FOXGLOVE DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5000
Mailing Address - Country:US
Mailing Address - Phone:908-604-6350
Mailing Address - Fax:
Practice Address - Street 1:16 FOXGLOVE DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5000
Practice Address - Country:US
Practice Address - Phone:908-604-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08715200207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine