Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 044120 | NY |
NPI | 1093295537 |
---|---|
Provider Name | Casey Jackson Calabrese |
First Address | Clarence Center, NY 14032-9756 |
Second Address | Buffalo, NY 14222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 17/04/2019 |