Provider Demographics
NPI:1932550878
Name:COLUCCI, KATE NICOLE
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:NICOLE
Last Name:COLUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PENN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3807
Mailing Address - Country:US
Mailing Address - Phone:631-384-5339
Mailing Address - Fax:
Practice Address - Street 1:49 PENN ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3807
Practice Address - Country:US
Practice Address - Phone:631-384-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist