Provider Demographics
NPI:1669461273
Name:COLL, DEIRDRE M (MD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:M
Last Name:COLL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:ONE GUSTAVE LEVY PLACE
Mailing Address - Street 2:BOX 1234
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-6381
Mailing Address - Fax:212-410-1973
Practice Address - Street 1:1900 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 500
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1724
Practice Address - Country:US
Practice Address - Phone:212-542-1090
Practice Address - Fax:516-794-8165
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2153872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV01976705Medicaid
NYH04893Medicare UPIN
NV01976705Medicaid