Provider Demographics
NPI:1720113137
Name:VATALARO, COLLEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:VATALARO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLUE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11715-2006
Mailing Address - Country:US
Mailing Address - Phone:631-363-2260
Mailing Address - Fax:
Practice Address - Street 1:405 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1651
Practice Address - Country:US
Practice Address - Phone:631-567-3320
Practice Address - Fax:631-567-3285
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256103-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY256103-1OtherLICENSE NUMBER