Provider Demographics
NPI:1225110695
Name:COLLINS, ADRIANE J (DO)
Entity Type:Individual
Prefix:
First Name:ADRIANE
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ADRIANE
Other - Middle Name:J
Other - Last Name:DEANGELIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:125 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2023
Mailing Address - Country:US
Mailing Address - Phone:631-376-6075
Mailing Address - Fax:631-376-6091
Practice Address - Street 1:125 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2023
Practice Address - Country:US
Practice Address - Phone:631-376-6075
Practice Address - Fax:631-376-6091
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186715174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG15456Medicare UPIN
NY74200YXRV1Medicare PIN