Provider Demographics
NPI:1700818143
Name:COLLINS, RONALD LEOPOLD (MD,)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEOPOLD
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 1:7616 BAY PKWY
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1516
Mailing Address - Country:US
Mailing Address - Phone:718-837-7400
Mailing Address - Fax:718-837-7402
Practice Address - Street 1:7616 BAY PKWY
Practice Address - Street 2:SUITE # 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1516
Practice Address - Country:US
Practice Address - Phone:718-837-7400
Practice Address - Fax:718-837-7402
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148910225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01970878Medicaid
NY01970878Medicaid
NY89E741Medicare ID - Type Unspecified