Provider Demographics
NPI:1487830238
Name:COLLINS WELLCARE MEDICAL, P.C.
Entity Type:Organization
Organization Name:COLLINS WELLCARE MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-300-7130
Mailing Address - Street 1:7616 BAY PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1516
Mailing Address - Country:US
Mailing Address - Phone:718-232-1910
Mailing Address - Fax:718-232-1932
Practice Address - Street 1:7616 BAY PKWY STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1516
Practice Address - Country:US
Practice Address - Phone:718-232-1910
Practice Address - Fax:718-232-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148940207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXTVW1Medicare PIN