Provider Demographics
NPI:1972599645
Name:COLLIGAN, EILEEN FRANCES (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:FRANCES
Last Name:COLLIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:21 ORCHARD STREET
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5004
Mailing Address - Country:US
Mailing Address - Phone:845-343-7614
Mailing Address - Fax:845-343-5390
Practice Address - Street 1:53 GIBSON ROAD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924
Practice Address - Country:US
Practice Address - Phone:845-291-0100
Practice Address - Fax:845-343-5390
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125788207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SERIAL # 001120OtherUSCG CERTIFICATE OF REGISTRY - MEDICAL DOCTOR
NY00399284Medicaid
NY125788OtherMEDICAL LICENSE
NJ25MA0414310OtherMEDICAL LICENSE
1306096318OtherGROUP ORGANIZATION NPI
NY10507901OtherCAQH PROVIDER ID #
NY10507901OtherCAQH PROVIDER ID #
NY10507901OtherCAQH PROVIDER ID #
NY125788OtherMEDICAL LICENSE