Provider Demographics
NPI:1427118140
Name:CALDERON, CECILIA GRISELDA (MD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:GRISELDA
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 1:1262 BOSTON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3602
Mailing Address - Country:US
Mailing Address - Phone:718-569-7929
Mailing Address - Fax:347-590-5482
Practice Address - Street 1:1262 BOSTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3602
Practice Address - Country:US
Practice Address - Phone:718-569-7929
Practice Address - Fax:347-590-5482
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY255626OtherMEDICAL LICENSE
NY02932589Medicaid
NY255626OtherMEDICAL LICENSE