Provider Demographics
NPI:1699840074
Name:COLAVITO, JENNIFER (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:COLAVITO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E 57TH ST STE 1502
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2780
Mailing Address - Country:US
Mailing Address - Phone:212-688-0618
Mailing Address - Fax:212-688-0615
Practice Address - Street 1:136 E 57TH ST STE 1502
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2780
Practice Address - Country:US
Practice Address - Phone:212-688-0618
Practice Address - Fax:212-688-0615
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006115152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02118165Medicaid
NY02118165Medicaid
NYU88839Medicare UPIN