Provider Demographics
NPI:1962444976
Name:CALLAHAN, TROY EZRA (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:EZRA
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 ROCKWOOD PL STE 405
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4960
Mailing Address - Country:US
Mailing Address - Phone:201-225-1811
Mailing Address - Fax:201-616-7789
Practice Address - Street 1:25 ROCKWOOD PL STE 405
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4960
Practice Address - Country:US
Practice Address - Phone:201-225-1811
Practice Address - Fax:201-616-7789
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206666-1208200000X
NJ25MA0811800208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
205427950OtherEIN
I34561Medicare UPIN