Provider Demographics
NPI:1851482251
Name:MICHAEL A. KALVERT MD PC
Entity Type:Organization
Organization Name:MICHAEL A. KALVERT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-638-2101
Mailing Address - Street 1:365 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3061
Mailing Address - Country:US
Mailing Address - Phone:845-638-2101
Mailing Address - Fax:845-638-0418
Practice Address - Street 1:365 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3061
Practice Address - Country:US
Practice Address - Phone:845-638-2101
Practice Address - Fax:845-638-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD103700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00502612Medicaid
NY287311Medicare ID - Type Unspecified
NY00502612Medicaid