Basic Information
Provider Information
NPI: 1154377687
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALABRESE
FirstName: KAREN
MiddleName: ANN
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 FEDERAL ST # 200
Address2:  
City: CAMDEN
State: NJ
PostalCode: 081031088
CountryCode: US
TelephoneNumber: 8563564924
FaxNumber:  
Practice Location
Address1: 500 BERLIN CROSS KEYS RD
Address2:  
City: SICKLERVILLE
State: NJ
PostalCode: 080814355
CountryCode: US
TelephoneNumber: 8565361515
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/26/2006
LastUpdateDate: 11/30/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X25MB07810600NJY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


Home