Provider Demographics
NPI:1306876479
Name:CALUYA, FREDERICK (LPT)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:CALUYA
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N WOOD AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-5200
Mailing Address - Country:US
Mailing Address - Phone:908-474-9444
Mailing Address - Fax:908-474-8561
Practice Address - Street 1:10 N WOOD AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-5200
Practice Address - Country:US
Practice Address - Phone:908-474-9444
Practice Address - Fax:908-474-8561
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01004300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ068480OtherMEDICARE GROUP #
NJ40QA01004300OtherPHYSICAL THERAPIST LICENS
NJ40QA01004300OtherPHYSICAL THERAPIST LICENS