Provider Demographics
NPI:1730464025
Name:MCMANUS-SARUBBI, COLLEEN ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ANN
Last Name:MCMANUS-SARUBBI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GILLIGAN RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1715
Mailing Address - Country:US
Mailing Address - Phone:518-207-2490
Mailing Address - Fax:518-477-2667
Practice Address - Street 1:35 GILLIGAN RD
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-1715
Practice Address - Country:US
Practice Address - Phone:518-207-2490
Practice Address - Fax:518-477-2667
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325498-1251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01409145Medicaid