Provider Demographics
NPI:1790909885
Name:COLUCCI, MYLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:MYLENE
Middle Name:
Last Name:COLUCCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SCHOOL ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2548
Mailing Address - Country:US
Mailing Address - Phone:516-676-2878
Mailing Address - Fax:516-674-2256
Practice Address - Street 1:3 SCHOOL ST
Practice Address - Street 2:SUITE 303
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2548
Practice Address - Country:US
Practice Address - Phone:516-676-2878
Practice Address - Fax:516-674-2256
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162038207RP1001X
NY226904207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY226904OtherLICENSE