Provider Demographics
NPI:1639481112
Name:CALIXTE, TEDDY JEAN (PA)
Entity Type:Individual
Prefix:
First Name:TEDDY
Middle Name:JEAN
Last Name:CALIXTE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2330 HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2841
Mailing Address - Country:US
Mailing Address - Phone:718-801-3104
Mailing Address - Fax:516-502-6331
Practice Address - Street 1:2330 HOFFMAN AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2841
Practice Address - Country:US
Practice Address - Phone:718-801-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical