Provider Demographics
NPI:1861041279
Name:RECORE, COLLIN SAMUEL
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:SAMUEL
Last Name:RECORE
Suffix:
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 1:214 CANNING RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC
Mailing Address - State:NY
Mailing Address - Zip Code:12981-3211
Mailing Address - Country:US
Mailing Address - Phone:518-354-0872
Mailing Address - Fax:
Practice Address - Street 1:375 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-4124
Practice Address - Country:US
Practice Address - Phone:413-662-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program