Provider Demographics
NPI:1801402599
Name:BENT, COLLETTE S
Entity Type:Individual
Prefix:MRS
First Name:COLLETTE
Middle Name:S
Last Name:BENT
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 1:11226 208TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2206
Mailing Address - Country:US
Mailing Address - Phone:718-776-3358
Mailing Address - Fax:
Practice Address - Street 1:11226 208TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2206
Practice Address - Country:US
Practice Address - Phone:718-776-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13922572011744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty