Provider Demographics
NPI:1932355732
Name:DAVID A. COLBERT M.D., P.C.
Entity Type:Organization
Organization Name:DAVID A. COLBERT M.D., P.C.
Other - Org Name:NEW YORK DERMATOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLAIMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-442-5002
Mailing Address - Street 1:119 5TH AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1007
Mailing Address - Country:US
Mailing Address - Phone:212-533-8888
Mailing Address - Fax:212-673-5185
Practice Address - Street 1:119 5TH AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1007
Practice Address - Country:US
Practice Address - Phone:212-533-8888
Practice Address - Fax:212-673-5185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEU961Medicare PIN