Provider Demographics
NPI:1861570202
Name:RICHARD COLLENS MD PC
Entity type:Organization
Organization Name:RICHARD COLLENS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-222-7071
Mailing Address - Street 1:697 W END AVE
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6823
Mailing Address - Country:US
Mailing Address - Phone:212-222-7071
Mailing Address - Fax:212-222-1617
Practice Address - Street 1:697 W END AVE
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6823
Practice Address - Country:US
Practice Address - Phone:212-222-7071
Practice Address - Fax:212-222-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY99276207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWCW201Medicare ID - Type Unspecified