Provider Demographics
NPI:1639257835
Name:COLAKOVSKI, HRISTO NIKOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:HRISTO
Middle Name:NIKOLA
Last Name:COLAKOVSKI
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 1:1880 RIDGE RD E
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2473
Mailing Address - Country:US
Mailing Address - Phone:585-266-7540
Mailing Address - Fax:585-266-7406
Practice Address - Street 1:1880 RIDGE RD E
Practice Address - Street 2:SUITE 1B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2473
Practice Address - Country:US
Practice Address - Phone:585-266-7540
Practice Address - Fax:585-266-7406
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208580207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01789775Medicaid
NYBB4530Medicare ID - Type Unspecified
NY01789775Medicaid