Basic Information
Provider Information
NPI: 1790074748
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALENDA
FirstName: BRANDON
MiddleName: WILLIAM
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 416457
Address2:  
City: BOSTON
State: MA
PostalCode: 022416457
CountryCode: US
TelephoneNumber: 8443621735
FaxNumber: 9732907495
Practice Location
Address1: 242 W PARKWAY
Address2:  
City: POMPTON PLAINS
State: NJ
PostalCode: 074441029
CountryCode: US
TelephoneNumber: 9738317455
FaxNumber: 9738317585
Other Information
ProviderEnumerationDate: 03/30/2011
LastUpdateDate: 04/24/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X25MA10270700NJY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


Home