Provider Demographics
NPI:1932900198
Name:CALDERON DUARTE, MABEL SR (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:CALDERON DUARTE
Suffix:SR
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:DR
Other - First Name:MABEL
Other - Middle Name:CALDERON
Other - Last Name:DUARTE
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 DELAWARE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4734
Mailing Address - Country:US
Mailing Address - Phone:973-281-5960
Mailing Address - Fax:
Practice Address - Street 1:45 DELAWARE AVE APT 2
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4734
Practice Address - Country:US
Practice Address - Phone:973-281-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant