Provider Demographics
NPI:1508131780
Name:COLEMAN, DELROY ROBERT (PA)
Entity Type:Individual
Prefix:MR
First Name:DELROY
Middle Name:ROBERT
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4732
Mailing Address - Country:US
Mailing Address - Phone:718-607-1956
Mailing Address - Fax:
Practice Address - Street 1:1141 E 84TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4732
Practice Address - Country:US
Practice Address - Phone:718-607-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical