Provider Demographics
NPI:1720369481
Name:INGRASSIA, COLLEEN (PA)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:INGRASSIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:JANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9 SPARTON LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1316
Mailing Address - Country:US
Mailing Address - Phone:516-589-0719
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3816
Practice Address - Country:US
Practice Address - Phone:516-734-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014904363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical