Provider Demographics
NPI:1326229451
Name:OUDKERK, COLLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLIE
Middle Name:
Last Name:OUDKERK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BROOKDALE HOSPITAL MEDICAL CENTER
Mailing Address - Street 2:101-01 AVENUE D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:718-240-5132
Mailing Address - Fax:
Practice Address - Street 1:BROOKDALE HOSPITAL MEDICAL CENTER
Practice Address - Street 2:ONE BROOKDALE PLAZA
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:718-240-5363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204995146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01783471Medicaid