Basic Information
Provider Information
NPI: 1396123360
EntityType: 2
ReplacementNPI:  
OrganizationName: PARK HILL EMERGENCY PHYSICIAN SERVICES
LastName:  
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Mailing Information
Address1: 66 W GILBERT ST
Address2: SUITE 1
City: TINTON FALLS
State: NJ
PostalCode: 077014947
CountryCode: US
TelephoneNumber: 7322120060
FaxNumber:  
Practice Location
Address1: 127 S BROADWAY
Address2:  
City: YONKERS
State: NY
PostalCode: 107014006
CountryCode: US
TelephoneNumber: 9143787000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/11/2015
LastUpdateDate: 05/22/2015
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: CALABRO
AuthorizedOfficialFirstName: JOSEPH
AuthorizedOfficialMiddleName: J
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 7322120060
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DO
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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