Provider Demographics
NPI:1780003855
Name:CALDERON, BIANCA NILANI (MD)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:NILANI
Last Name:CALDERON
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 1:1110 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5375
Mailing Address - Country:US
Mailing Address - Phone:718-860-2515
Mailing Address - Fax:718-860-2519
Practice Address - Street 1:1110 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-860-2515
Practice Address - Fax:718-860-2519
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281985208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY281985OtherMEDICAL LICENSE
NY04797655Medicaid