Provider Demographics
NPI:1558455188
Name:COLADNER, ANDREA S (DO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:COLADNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4681 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4515
Mailing Address - Country:US
Mailing Address - Phone:631-737-5143
Mailing Address - Fax:631-737-5224
Practice Address - Street 1:4681 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4515
Practice Address - Country:US
Practice Address - Phone:631-737-5143
Practice Address - Fax:631-737-5224
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186786-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF82680Medicare UPIN
NY14J461Medicare PIN