Provider Demographics
NPI:1134181282
Name:COLLIN, PIERRE (MD)
Entity type:Individual
Prefix:
First Name:PIERRE
Middle Name:
Last Name:COLLIN
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 1:900 STRAIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3203
Mailing Address - Country:US
Mailing Address - Phone:631-957-0066
Mailing Address - Fax:631-957-2701
Practice Address - Street 1:900 STRAIGHT PATH
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-3203
Practice Address - Country:US
Practice Address - Phone:631-957-0066
Practice Address - Fax:631-957-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177092-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01177637Medicaid
NYE94647Medicare UPIN
NY01177637Medicaid