Provider Demographics
NPI:1114089430
Name:KOLIN, MICHAEL LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:KOLIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18 FROST POND DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2808
Mailing Address - Country:US
Mailing Address - Phone:917-533-3083
Mailing Address - Fax:212-768-1223
Practice Address - Street 1:512 FASHION AVE
Practice Address - Street 2:SUITE 1404-A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4603
Practice Address - Country:US
Practice Address - Phone:212-768-7979
Practice Address - Fax:212-768-1223
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009639-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1946771OtherOXFORD HEALTH PLANS
613941OtherUNITED HEALTHCARE
7654667OtherAETNA US HEALTHCARE