Provider Demographics
NPI:1770020745
Name:COLON, NIKIRAY I
Entity Type:Individual
Prefix:
First Name:NIKIRAY
Middle Name:
Last Name:COLON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E 197TH ST
Mailing Address - Street 2:APT# 5D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-3629
Mailing Address - Country:US
Mailing Address - Phone:917-655-4709
Mailing Address - Fax:
Practice Address - Street 1:320 E 197TH ST
Practice Address - Street 2:APT# 5D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3629
Practice Address - Country:US
Practice Address - Phone:917-655-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218848279104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker