Provider Demographics
NPI:1588036040
Name:PHYSICIANS COLLABORATIVE AFFILIATES, INC.
Entity type:Organization
Organization Name:PHYSICIANS COLLABORATIVE AFFILIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:
Authorized Official - Last Name:CONIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-523-0593
Mailing Address - Street 1:501 N ORLANDO AVE
Mailing Address - Street 2:SUITE 313, PMB 185
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7313
Mailing Address - Country:US
Mailing Address - Phone:407-803-4016
Mailing Address - Fax:407-803-4045
Practice Address - Street 1:101 E MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2123
Practice Address - Country:US
Practice Address - Phone:407-803-4016
Practice Address - Fax:407-803-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty