Provider Demographics
NPI:1689813818
Name:ESTES, CALVIN
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:
Last Name:ESTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 GRAND CONCOURSE
Mailing Address - Street 2:STE. 417
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:718-584-7205
Mailing Address - Fax:718-584-8394
Practice Address - Street 1:2488 GRAND CONCOURSE
Practice Address - Street 2:STE. 417
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-584-7205
Practice Address - Fax:718-584-8394
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY192488Medicaid