Provider Demographics
NPI:1598719106
Name:COLLINS, STEVEN MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1150
Mailing Address - Country:US
Mailing Address - Phone:855-593-1100
Mailing Address - Fax:585-596-4005
Practice Address - Street 1:5877 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813-9616
Practice Address - Country:US
Practice Address - Phone:585-268-5700
Practice Address - Fax:585-268-9192
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233806207Q00000X
NY233806-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02616562Medicaid
NYRA4432Medicare ID - Type Unspecified
NY02616562Medicaid