Provider Demographics
NPI:1609844463
Name:WATERTOWN INTERNISTS PC
Entity Type:Organization
Organization Name:WATERTOWN INTERNISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLINS
Authorized Official - Middle Name:F
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:315-782-2141
Mailing Address - Street 1:53-59 PUBLIC SQUARE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-782-2141
Mailing Address - Fax:315-782-5123
Practice Address - Street 1:53-59 PUBLIC SQUARE
Practice Address - Street 2:SUITE 301
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-782-2141
Practice Address - Fax:315-782-5123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01108621Medicaid
NYCN1323OtherRAILROAD MEDICARE
NY01108621Medicaid
NY01108621Medicaid
NY51583AMedicare PIN