Provider Demographics
NPI:1790767010
Name:COLBY-KREUGER, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:COLBY-KREUGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2407
Mailing Address - Country:US
Mailing Address - Phone:845-353-1441
Mailing Address - Fax:845-353-1987
Practice Address - Street 1:258 HIGH AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2407
Practice Address - Country:US
Practice Address - Phone:845-353-1441
Practice Address - Fax:845-353-1987
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001113174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010113OtherCONNECTICARE #
NY3450515OtherAETNA HMO #
NY1899671OtherGHI PPO #
NYCR1113OtherATLANTIS HEALTH PLAN #
NY000000087074OtherGHI HMO #
NY02518261Medicaid
NY366184OtherMVP #
NY7131533OtherAETNA PPO #
NYM0M691OtherEMPIRE BCBS #
NY0D3131OtherHEALTHNET #
NY1000041797OtherAFFINITY HEALTH PLAN #
NY246177OtherWELLCARE #
NY7131533OtherAETNA PPO #
NYM0M691Medicare PIN