Provider Demographics
NPI:1831258128
Name:COLAVITO, THOMAS ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:COLAVITO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 ROUTE 211 E
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2206
Mailing Address - Country:US
Mailing Address - Phone:845-344-1211
Mailing Address - Fax:845-344-4045
Practice Address - Street 1:453 ROUTE 211 E
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2206
Practice Address - Country:US
Practice Address - Phone:845-344-1211
Practice Address - Fax:845-344-4045
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0052191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX29431Medicare PIN