Provider Demographics
NPI:1508958141
Name:KOLENSKY, CLAIRE DIANE (MD)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:DIANE
Last Name:KOLENSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 FULTON STREET
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:516-845-1600
Mailing Address - Fax:516-845-5610
Practice Address - Street 1:850 FULTON STREET STE. 2
Practice Address - Street 2:PREMIER INTERNAL MEDICINE, PLLC
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735
Practice Address - Country:US
Practice Address - Phone:516-845-1600
Practice Address - Fax:516-845-5610
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG33964Medicare UPIN
NYG33964Medicare UPIN