Provider Demographics
NPI:1184214173
Name:FORESTANO, COLLRANE RACHAEL (PA)
Entity Type:Individual
Prefix:
First Name:COLLRANE
Middle Name:RACHAEL
Last Name:FORESTANO
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:19 BRADHURST AVE STE 3100N
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9028
Practice Address - Street 1:241 NORTH ROAD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12604-2140
Practice Address - Country:US
Practice Address - Phone:845-483-5989
Practice Address - Fax:845-483-5912
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY026039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant