Provider Demographics
NPI:1023223641
Name:COLACINO, CHRISTINE M (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:COLACINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WEST CARVER MEDICAL ASSOCIATES
Mailing Address - Street 2:200 WEST CARVER STREET
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3303
Mailing Address - Country:US
Mailing Address - Phone:631-421-0020
Mailing Address - Fax:631-421-0688
Practice Address - Street 1:WEST CARVER MEDICAL ASSOCIATES
Practice Address - Street 2:200 WEST CARVER ST.
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3303
Practice Address - Country:US
Practice Address - Phone:631-421-0020
Practice Address - Fax:631-421-0688
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301632-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner