Provider Demographics
NPI:1902858319
Name:COLLET, BRIAN IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:IRA
Last Name:COLLET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8439 153RD AVE
Mailing Address - Street 2:SUITE LM
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1957
Mailing Address - Country:US
Mailing Address - Phone:718-848-3909
Mailing Address - Fax:718-848-4107
Practice Address - Street 1:8439 153RD AVE
Practice Address - Street 2:SUITE LM
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1957
Practice Address - Country:US
Practice Address - Phone:718-848-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146921-01207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00999160Medicaid
NY35160Medicare ID - Type UnspecifiedGHI-MEDICARE
NY89D86Medicare ID - Type UnspecifiedEMPIRE-MEDICARE
NY00999160Medicaid