Provider Demographics
NPI:1437394376
Name:COLOSA, JEANNE MARIE
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:MARIE
Last Name:COLOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 S COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5637
Mailing Address - Country:US
Mailing Address - Phone:631-312-3295
Mailing Address - Fax:
Practice Address - Street 1:33 WALT WHITMAN RD
Practice Address - Street 2:SUITE 300B
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3640
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator