Provider Demographics
NPI:1962718742
Name:CALO, JASON JOSEPH (ATC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:JOSEPH
Last Name:CALO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1320
Mailing Address - Country:US
Mailing Address - Phone:973-571-6750
Mailing Address - Fax:973-571-6765
Practice Address - Street 1:151 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1320
Practice Address - Country:US
Practice Address - Phone:973-571-6750
Practice Address - Fax:973-571-6765
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001197002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer