Provider Demographics
NPI:1508546920
Name:CALDERON, ENRIQUE ELEZ (DPT)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:ELEZ
Last Name:CALDERON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 5TH AVE.
Mailing Address - Street 2:SUITE 6L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:914-400-1500
Mailing Address - Fax:914-478-8781
Practice Address - Street 1:594 BROADWAY
Practice Address - Street 2:SUITE 1207
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3289
Practice Address - Country:US
Practice Address - Phone:212-343-1500
Practice Address - Fax:212-343-1594
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY050061225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist