Provider Demographics
NPI:1851093124
Name:KALLOO, MATTHEW AARON
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:KALLOO
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:L.P.# 59 CHIN CHIN ROAD
Mailing Address - Street 2:CUNUPIA
Mailing Address - City:PORT OF SPAIN
Mailing Address - State:TT
Mailing Address - Zip Code:00000
Mailing Address - Country:TT
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:506 LENOX AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1889
Practice Address - Country:US
Practice Address - Phone:212-939-1406
Practice Address - Fax:212-939-1462
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program