Provider Demographics
NPI:1568085355
Name:COLON, STEVEN J
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:COLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 POOCHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTERFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03466-3517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 E 106TH ST APT 18E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4084
Practice Address - Country:US
Practice Address - Phone:917-755-7528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY706043163W00000X
VT026.0142843163W00000X
VT101.0134751363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse