Provider Demographics
NPI:1639326127
Name:CALLA, VENUS S (MD)
Entity Type:Individual
Prefix:DR
First Name:VENUS
Middle Name:S
Last Name:CALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4618
Mailing Address - Country:US
Mailing Address - Phone:917-531-2723
Mailing Address - Fax:718-780-7382
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3609
Practice Address - Country:US
Practice Address - Phone:917-531-2723
Practice Address - Fax:718-780-7382
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 250052208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation