Provider Demographics
NPI:1184862179
Name:COLODNY, NIKKI (MD)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:COLODNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DANDY DR
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2203
Mailing Address - Country:US
Mailing Address - Phone:203-273-0502
Mailing Address - Fax:
Practice Address - Street 1:1039 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4108
Practice Address - Country:US
Practice Address - Phone:203-975-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219718207Q00000X
CT045745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine